AIM： To search for transcription dysregulation that could （1） differentiate hepatocellular carcinoma （HCC）-free from HCC-related cirrhosis （2） differentiate HCC-free cirrhosis related to HCV from that related t...AIM： To search for transcription dysregulation that could （1） differentiate hepatocellular carcinoma （HCC）-free from HCC-related cirrhosis （2） differentiate HCC-free cirrhosis related to HCV from that related to alcohol intake. METHODS： Using microarray analysis, we compared transcript levels in HCC-free cirrhosis （alcoholism： 7; hepatitis C： 7）, HCC-associated cirrhosis （alcoholism： 10; hepatitis C： 10） and eight control livers. The identified transcripts were validated by qRT-PCR in an independent cohort of 45 samples （20 HCC-free cirrhosis; 15 HCC-associated cirrhosis and 10 control livers）. We also confirmed our results by immunohistochemistry.RESULTS： In HCC-free livers, we identified 70transcripts which differentiated between alcoholicrelated-cirrhosis, HCV-related cirrhosis and control livers. They mainly corresponded to down-regulation. Dysregulation of Signal Transduction and Activator of Transcription-3 （STAT-3） was found along with related changes in STAT-3 targets which occurred in an etiology-dependent fashion in HCC-free cirrhosis. In contrast, in HCC, such transcription dysregulations were not observed. CONCLUSION： We report that transcriptional dysregulations exist in HCC-free cirrhosis, are transiently observed prior to detectable HCC onset and may be appear like markers from cirrhosis to HCC transition.展开更多
Situs inversus is an abnormal placement of the thoracic and/or abdominal organs that are inverted right/left from normal. It is a rare congenital malformation often discovered in childhood. In adults, it can lead to m...Situs inversus is an abnormal placement of the thoracic and/or abdominal organs that are inverted right/left from normal. It is a rare congenital malformation often discovered in childhood. In adults, it can lead to misdiagnosis. Clinical case: A 35-year-old female patient, seen in a hepatogastroenterology consultation for acute spontaneous pain in the right hypochondrium. She had no particular clinical history. A diagnosis of hepatopathy was suspected. Abdominal and pelvic CT scans showed the left liver, stomach and spleen in the right hypochondrium, but with the heart in place, suggesting incomplete situs inversus. The evolution in our patient was spontaneously resolved with analgesics and antispasmodics, which leads us to believe that the volvulus was probably partial and without other complications. Conclusion: In developing countries, antenatal diagnosis of situs inversus is rare and is usually made during a pathology that leads the patient to a medical consultation. CT is one of the key paraclinical examinations for its diagnosis as genetic tests are not widely available.展开更多
AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free ...AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3） （P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.展开更多
AIM:To look at a comprehensive picture of etiology- dependent gene abnormalities in hepatocellular carcinoma in Western Europe. METHODS:With a liver-oriented microarray,transcript levels were compared in nodules and c...AIM:To look at a comprehensive picture of etiology- dependent gene abnormalities in hepatocellular carcinoma in Western Europe. METHODS:With a liver-oriented microarray,transcript levels were compared in nodules and cirrhosis from a training set of patients with hepatocellular carcinoma (alcoholism,12;hepatitis C,10)and 5 controls.Loose or tight selection of informative transcripts with an abnormal abundance was statistically valid and the tightly selected transcripts were next quantified by qRTPCR in the nodules from our training set(12+10) and a test set(6+7). RESULTS:A selection of 475 transcripts pointed to significant gene over-representation on chromosome 8 (alcoholism)or-2(hepatitis C)and ontology indicated a predominant inflammatory response(alcoholism)or changes in cell cycle regulation,transcription factors and interferon responsiveness(hepatitis C).A stringent selection of 23 transcripts whose differences betweenetiologies were significant in nodules but not in cirrhotic tissue indicated that the above dysregulations take place in tumor but not in the surrounding cirrhosis.These 23 transcripts separated our test set according to etiologies. The inflammation-associated transcripts pointed to limited alterations of free iron metabolism in alcoholic vs hepatitis C tumors. CONCLUSION:Etiology-specific abnormalities(chromo- some preference;differences in transcriptomes and related functions)have been identified in hepatocellular carcinoma driven by alcoholism or hepatitis C.This may open novel avenues for differential therapies in this disease.展开更多
The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We r...The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.展开更多
Introduction-Diagnosis of complications of small-bowel diverticulosis is difficult in the emergency setting and often delays surgical management. The aim of this study was to report our experience with seven patients ...Introduction-Diagnosis of complications of small-bowel diverticulosis is difficult in the emergency setting and often delays surgical management. The aim of this study was to report our experience with seven patients presenting with a surgical complication of small-bowel diverticulosis. Patients and methods-From January 1, 1995 to June 30, 2001, 7 patients presenting with a complication of small-bowel diverticulosis were included in this retrospective study. The mean age of the patients was 73.1 years. Complications were bleeding in 4 cases and diverticulitis with perforation and abscess formation in 3 cases. Results-The time between complication onset and its management was 20.6 days. Among paraclinical examinations small-bowel barium opacification showed diverticulosis in 4 cases. Other investigations such as endoscopy or CT-Scan imaging studies were used to eliminate other causes of acute abdomen. Patients were operated on in all cases and a segmental small bowel resection was performed in all cases while in one patient, a diversion stomy was performed. One patient died following septic peritonitis treatment. Conclusion-Small-bowel diverticulosis is unfrequent. In cases of gastrointestinal haemorrhage or occlusion, diagnosis is performed by eliminating other more frequent causes. If emergency surgery is not required, barium opacification seems to be the most sensitive examination.展开更多
PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 co...PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.展开更多
Aims-To assess the results of laparoscopic liver resection for hepatocellular carcinoma. Patients and methods-From 1998 to 2003, 12 laparoscopic liver resections for hepatocellular carcinoma were performed. Results-Th...Aims-To assess the results of laparoscopic liver resection for hepatocellular carcinoma. Patients and methods-From 1998 to 2003, 12 laparoscopic liver resections for hepatocellular carcinoma were performed. Results-There were no operative complications and no deaths. Conversion to laparotomy was required in one patient (8%) and transfusion in three patients (25%). One patient died of liver failure. Postoperative complications occurred in three patients (25%): trocar site bleeding, cardiac failure and biliary collection. The mean hospital stay was 5 days. No ascites and no transient liver failure occurred. During the mean follow up of 15 months the recurrence rate was 45.5%. No port site or peritoneal metastases were observed. Treatment of recurrence was second resection in two patients andmicrowave coagulation therapy in two other patients. Mean survival was 24 months. Conclusion-Laparoscopic liver resection is feasible in hepatocellular carcinoma if the tumor is unique, smaller than 5 centimeters and located in the left lateral segments or in the anterior or inferior segments of the right liver. Postoperative morbidity is low and long-term results seem to be similar to laparotomy.展开更多
基金Supported by In part by Grants from A.R.C.,Ligue contre le Cancer,I.R.E.B. and Conseil Régional de Haute-Normandie to J.P.S.
文摘AIM： To search for transcription dysregulation that could （1） differentiate hepatocellular carcinoma （HCC）-free from HCC-related cirrhosis （2） differentiate HCC-free cirrhosis related to HCV from that related to alcohol intake. METHODS： Using microarray analysis, we compared transcript levels in HCC-free cirrhosis （alcoholism： 7; hepatitis C： 7）, HCC-associated cirrhosis （alcoholism： 10; hepatitis C： 10） and eight control livers. The identified transcripts were validated by qRT-PCR in an independent cohort of 45 samples （20 HCC-free cirrhosis; 15 HCC-associated cirrhosis and 10 control livers）. We also confirmed our results by immunohistochemistry.RESULTS： In HCC-free livers, we identified 70transcripts which differentiated between alcoholicrelated-cirrhosis, HCV-related cirrhosis and control livers. They mainly corresponded to down-regulation. Dysregulation of Signal Transduction and Activator of Transcription-3 （STAT-3） was found along with related changes in STAT-3 targets which occurred in an etiology-dependent fashion in HCC-free cirrhosis. In contrast, in HCC, such transcription dysregulations were not observed. CONCLUSION： We report that transcriptional dysregulations exist in HCC-free cirrhosis, are transiently observed prior to detectable HCC onset and may be appear like markers from cirrhosis to HCC transition.
文摘Situs inversus is an abnormal placement of the thoracic and/or abdominal organs that are inverted right/left from normal. It is a rare congenital malformation often discovered in childhood. In adults, it can lead to misdiagnosis. Clinical case: A 35-year-old female patient, seen in a hepatogastroenterology consultation for acute spontaneous pain in the right hypochondrium. She had no particular clinical history. A diagnosis of hepatopathy was suspected. Abdominal and pelvic CT scans showed the left liver, stomach and spleen in the right hypochondrium, but with the heart in place, suggesting incomplete situs inversus. The evolution in our patient was spontaneously resolved with analgesics and antispasmodics, which leads us to believe that the volvulus was probably partial and without other complications. Conclusion: In developing countries, antenatal diagnosis of situs inversus is rare and is usually made during a pathology that leads the patient to a medical consultation. CT is one of the key paraclinical examinations for its diagnosis as genetic tests are not widely available.
文摘AIM： To assess pre-orthotopic liver transplantation （OLT） factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma （HCC） recurrence and disease-free survival after liver transplantation （LT）.METHODS： Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS： Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were： presence of cirrhosis （P = 0.001）, etiology of liver disease （P = 0.03）, α fetoprotein level （〈 200, 200 to 2000, or 〉 2000; P 〈 0.0001）, y-GT activity （N, N to 2N or 〉 2N; P = 0.02）, the number of nodules （1, 2-3 or ≥ 4; P = 0.02）, maximal diameter of the largest nodule （〈 3 cm, 3 to 5 cm or 〉 5 cm; P 〈 0.0001）, the sum of the diameter of the nodules （〈 3 cm, 3 to 5 cm, 5 to 10 cm or 〉10 cm; P 〈 0.0001）, bilobar location （P = 0.01）, preoperative portal thrombosis （P 〈 0.0001）, peri-operative treatment of the tumor （P = 0.002） and chemoembolization （P = 0.03）, tumor differentiation （P = 0.01）, initial type of calcineurin inhibitor （P = 0.003）, the use of antilymphocyte antibodies （P = 0.02）, rejection episodes （P = 0.003） and period of LT （P 〈 0.0001）. By multivariate analysis, 6 variables were independently associated with HCC recurrence： maximal diameter of the largest nodule （P 〈 0.0001）, time of LT （P 〈 0.0001）, tumor differentiation （P 〈 0.0001）, use of anti-lymphocyte antibody （ATG） or anti-CD3 antibody （OKT3） （P = 0.005）, preoperative portal thrombosis （P = 0.06） and the number of nodules （P = 0.06）. CONCLUSION： This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.
基金Grants from ANRS,ARC,IREB and ConseilRégional de Haute-Normandie to JPS
文摘AIM:To look at a comprehensive picture of etiology- dependent gene abnormalities in hepatocellular carcinoma in Western Europe. METHODS:With a liver-oriented microarray,transcript levels were compared in nodules and cirrhosis from a training set of patients with hepatocellular carcinoma (alcoholism,12;hepatitis C,10)and 5 controls.Loose or tight selection of informative transcripts with an abnormal abundance was statistically valid and the tightly selected transcripts were next quantified by qRTPCR in the nodules from our training set(12+10) and a test set(6+7). RESULTS:A selection of 475 transcripts pointed to significant gene over-representation on chromosome 8 (alcoholism)or-2(hepatitis C)and ontology indicated a predominant inflammatory response(alcoholism)or changes in cell cycle regulation,transcription factors and interferon responsiveness(hepatitis C).A stringent selection of 23 transcripts whose differences betweenetiologies were significant in nodules but not in cirrhotic tissue indicated that the above dysregulations take place in tumor but not in the surrounding cirrhosis.These 23 transcripts separated our test set according to etiologies. The inflammation-associated transcripts pointed to limited alterations of free iron metabolism in alcoholic vs hepatitis C tumors. CONCLUSION:Etiology-specific abnormalities(chromo- some preference;differences in transcriptomes and related functions)have been identified in hepatocellular carcinoma driven by alcoholism or hepatitis C.This may open novel avenues for differential therapies in this disease.
文摘The most common vascular complication of acute pancreatitis is thrombosis of the splenic vein. Isolated thrombosis of the superior mesenteric vein is rare and may lead to mesenteric ischemia and bowel infarction. We report the case of a 39 years old patient received for acute pancreatitis with a Ranson score less than 3 and image scanner for a grade C of Balthazar and a superior mesenteric vein thrombosis. The outcome was favorable with improvement of symptoms under medical treatment including anti-coagulant therapy. The contrast enhancing abdominal CT showed an absence of superior mesenteric thrombosis.
文摘Introduction-Diagnosis of complications of small-bowel diverticulosis is difficult in the emergency setting and often delays surgical management. The aim of this study was to report our experience with seven patients presenting with a surgical complication of small-bowel diverticulosis. Patients and methods-From January 1, 1995 to June 30, 2001, 7 patients presenting with a complication of small-bowel diverticulosis were included in this retrospective study. The mean age of the patients was 73.1 years. Complications were bleeding in 4 cases and diverticulitis with perforation and abscess formation in 3 cases. Results-The time between complication onset and its management was 20.6 days. Among paraclinical examinations small-bowel barium opacification showed diverticulosis in 4 cases. Other investigations such as endoscopy or CT-Scan imaging studies were used to eliminate other causes of acute abdomen. Patients were operated on in all cases and a segmental small bowel resection was performed in all cases while in one patient, a diversion stomy was performed. One patient died following septic peritonitis treatment. Conclusion-Small-bowel diverticulosis is unfrequent. In cases of gastrointestinal haemorrhage or occlusion, diagnosis is performed by eliminating other more frequent causes. If emergency surgery is not required, barium opacification seems to be the most sensitive examination.
文摘PURPOSE: This prospective study was designed to identify factors that could predict conversion in patients undergoing first laparoscopic ileocecal resection for Crohn’ s disease. METHODS: Between 1998 and 2004, 69 consecutive patients (32 males; mean age, 32 ± 9 years) who had undergone a first laparoscopic ileocecal resection for Crohn’ s disease were included in a prospective study. Twenty-one patients (30 percent) were converted into laparotomy. Possible factors for conversion were analyzed by both univariate and multivariate analyses. RESULTS: No patient died. Four patients (9 percent; 2 in each group) required five reoperations because of intraperitoneal hemorrhage (n = 1), anastomotic fistula (n = 3), and small bowel obstruction (n = 1). Mean hospital stay was significantly increased in converted compared with laparoscopic patients (9 ± 4 vs. 7 ± 3 days; P < 0.05). On univariate analysis, more than three episodes of acute flare of Crohn’ s disease (P = 0.02), male gender (P = 0.03), preoperative immunosuppressive drugs (P = 0.04), intra-abdominal abscess or fistula at the time of laparoscopy (P = 0.02), and resection of other intestinal segment (P = 0.02) were factors that predicted conversion. On multivariate analysis, recurrent medical episodes of Crohn’ s disease (odds ratio, 2; 95 percent confidence interval, 1-4), and intra-abdominal abscess or fistula at the time of laparoscopy (odds ratio, 15; 95 percent confidence interval, 4-78) were the two independent risk factors for conversion. CONCLUSIONS: This prospective study demonstrated that the severity of the disease increased significantly the conversion rate of the first laparoscopic ileocecal resection. Knowledge of these risk factors for conversion could be helpful in preoperative preparation and counseling of patients.
文摘Aims-To assess the results of laparoscopic liver resection for hepatocellular carcinoma. Patients and methods-From 1998 to 2003, 12 laparoscopic liver resections for hepatocellular carcinoma were performed. Results-There were no operative complications and no deaths. Conversion to laparotomy was required in one patient (8%) and transfusion in three patients (25%). One patient died of liver failure. Postoperative complications occurred in three patients (25%): trocar site bleeding, cardiac failure and biliary collection. The mean hospital stay was 5 days. No ascites and no transient liver failure occurred. During the mean follow up of 15 months the recurrence rate was 45.5%. No port site or peritoneal metastases were observed. Treatment of recurrence was second resection in two patients andmicrowave coagulation therapy in two other patients. Mean survival was 24 months. Conclusion-Laparoscopic liver resection is feasible in hepatocellular carcinoma if the tumor is unique, smaller than 5 centimeters and located in the left lateral segments or in the anterior or inferior segments of the right liver. Postoperative morbidity is low and long-term results seem to be similar to laparotomy.
