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Dissaux B, Duigou M, Herteleer M, Lefèvre C, Baqué P, Seizeur R. A national survey to assess the state of anatomy teaching in France across various disciplines and professions. Surg Radiol Anat 2024; 46:391-398. [PMID: 38436731 DOI: 10.1007/s00276-024-03310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To investigate the current practices in anatomy teaching at French universities in 2023. METHODS On January 10, 2023, a questionnaire was sent to all members of the official list of the French Medical College of Professors of Anatomy. Each Anatomy centre was asked to complete this online form only once. The questionnaire covered several key themes, including broad questions, dissections practices, "virtual" dissections, teaching methods and teaching staff. RESULTS The questionnaire was completed by 26/28 anatomy centres. Access to body donor dissection is reported to be mandatory in 15 of the 26 centers (58%), optional in 10 centers (38%), and "tolerated" in one center (4%). Fifteen of 26 centers (58%) reported having a virtual dissection table for teaching anatomy. Concerning the teaching of anatomy via live ultrasound, 10 out of 26 centers (38%) reported providing it. Regarding the teaching methods used for medical students, chalk and board lectures are the most common method, although the intensity of use varies. Most lectures are given with chalk and board in 42% (11/26) of the centers. In about 73% (19/26) of the centers, tablet lectures are used. Regarding anatomy teachers, it was reported that in 24/26 anatomy centres (92%), more than 50% of the courses for medical students are taught by professors holding the chair of anatomy (21/26 professors (81%), 3/26 associate professors (12%)). CONCLUSION The present study endeavors to contribute to the existing body of knowledge on anatomy education by offering insights into the current practices in French universities.
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Affiliation(s)
- Brieg Dissaux
- Anatomy Department, University of Western Brittany (UBO), Brest, France.
- Inserm, Univ Brest, CHRU Brest, UMR 1304, GETBO, Brest, France.
- Radiology Department, University Hospital, Brest, France.
| | - Marie Duigou
- Anatomy Department, University of Western Brittany (UBO), Brest, France
- Neurosurgery Department, University Hospital, Brest, France
| | - Matthias Herteleer
- Anatomy Laboratory, Lille University School of Medicine, University of Lille, Lille, France
- Department of Anesthesiology and Critical Care Medicine, University Hospital of Lille, Lille, France
| | - Christian Lefèvre
- Anatomy Department, University of Western Brittany (UBO), Brest, France
- LaTIM, INSERM 1101, Brest, France
| | - Patrick Baqué
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France
- Acute Care Surgery, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 Voie Romaine, 06100, Nice, France
| | - Romuald Seizeur
- Anatomy Department, University of Western Brittany (UBO), Brest, France
- Neurosurgery Department, University Hospital, Brest, France
- LaTIM, INSERM 1101, Brest, France
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Etienne JH, Salucki B, Gridel V, Orban JC, Baqué P, Massalou D. Low-Impact Laparoscopy vs Conventional Laparoscopy for Appendectomy: A Prospective Randomized Trial. J Am Coll Surg 2023; 237:622-631. [PMID: 37382370 DOI: 10.1097/xcs.0000000000000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Low-impact laparoscopy (LIL), combining low-pressure insufflation and microlaparoscopy, is a surgical technique that is still not widely used and that has never been evaluated for the management of acute appendicitis. The aim of this study is to assess the feasibility of an LIL protocol, to compare postoperative pain, average length of stay, and in-hospital use of analgesics by patients who underwent appendectomy according to a conventional laparoscopy or an LIL protocol. STUDY DESIGN Patients presenting with acute uncomplicated appendicitis who were operated on between January 1, 2021, and July 10, 2022, were included in this double-blind, single-center, prospective study. They were preoperatively randomly assigned to a group undergoing conventional laparoscopy, ie with an insufflation pressure of 12 mmHg and conventional instrumentation, and an LIL group, with an insufflation pressure of 7 mmHg and microlaparoscopic instrumentation. RESULTS Fifty patients were included in this study, 24 in the LIL group and 26 in the conventional group. There were no statistically significant differences between the 2 patient groups, including weight and surgical history. The postoperative complication rate was comparable between the 2 groups (p = 0.81). Pain was reported as significantly lower according to the visual analog scale 2 hours after surgery among the LIL group (p = 0.019). For patients who underwent surgery according to the LIL protocol, the study confirms a statistically significant difference for theoretical and actual length of stay, ie -0.77 days and -0.59 days, respectively (p < 0.001 and p = 0.03). In-hospital use of analgesics was comparable between both groups. CONCLUSIONS In uncomplicated acute appendicitis, the LIL protocol could reduce postoperative pain and average length of stay compared to conventional laparoscopic appendectomy.
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Affiliation(s)
- Jean-Hubert Etienne
- From the Acute Care Surgery (Etienne, Salucki, Baque, Massalou), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Benjamin Salucki
- From the Acute Care Surgery (Etienne, Salucki, Baque, Massalou), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- Digestive Surgery, Centre Hospitalier de la Fontonne, Antibes, France (Salucki)
| | - Victor Gridel
- Anesthesia Department (Gridel, Orban), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Jean-Christophe Orban
- Anesthesia Department (Gridel, Orban), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Patrick Baqué
- From the Acute Care Surgery (Etienne, Salucki, Baque, Massalou), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Damien Massalou
- From the Acute Care Surgery (Etienne, Salucki, Baque, Massalou), Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
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Massalou D, Bronsard N, Hekayem L, Baqué P, Camuzard O. Modern and synchronized clinical anatomy teaching based on the BDIE method (board-digital dissection-imaging-evaluation). Surg Radiol Anat 2022; 44:803-808. [PMID: 35482103 DOI: 10.1007/s00276-022-02943-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Anatomy has historically been taught via traditional medical school lectures and dissection. In many countries, practical or legal issues limit access to cadaveric dissection. New technologies are favored by students and could improve learning, complementing traditional teaching. METHODS All students in second-year medicine at a single medical school were submitted to a novel anatomical course with digital tool exposure. We explored a new combined teaching method: a physical blackboard lesson synchronized with digital dissection, imaging and direct evaluation (BDIE). Synchronized dissection is broadcast live in the classroom and in partner medical schools. Following the course, students completed a short survey about their perception of this new anatomic clinical course. RESULTS The survey included 183 students whom 178 completed the questionnaire, i.e., a 97% response rate. Ninety-nine percent of students thought this synchronized method useful to improve their understanding of anatomy and 90% stated it helped them retain this learning. CONCLUSION This BDIE method, in conjunction with teaching guidelines and dissection, is highly appreciated by students who consider it helps them to acquire lasting knowledge.
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Affiliation(s)
- Damien Massalou
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France.
- Acute Care Surgery, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France.
- Chirurgie Générale d'Urgence, Hôpital Pasteur 2, 30 voie romaine, 06000, Nice, France.
| | - Nicolas Bronsard
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France
- Orthopedic Department, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France
| | - Laurent Hekayem
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France
- Department of Emergency Medicine, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France
| | - Patrick Baqué
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France
- Acute Care Surgery, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France
| | - Olivier Camuzard
- Department of Anatomy, School of Medicine, Université Nice Sophia Antipolis/Université Côte d'Azur, 28 Avenue de Valombrose, 06100, Nice, France
- Hand Surgery Department, University Hospital of Nice, CHU de Nice, Hôpital Pasteur 2, 30 voie Romaine, 06100, Nice, France
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Cegarra-Escolano M, Jaloux C, Poumellec MA, Balaguer T, Baqué P, Bronsard N, Camuzard O. Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study. Hand Surg Rehabil 2021; 40:241-249. [PMID: 33757862 DOI: 10.1016/j.hansur.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/28/2022]
Abstract
The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.
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Affiliation(s)
- M Cegarra-Escolano
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - C Jaloux
- Department of Plastic and Reconstructive Surgery, La Conception Hospital, Marseille, France
| | - M-A Poumellec
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - T Balaguer
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - P Baqué
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, 30 Voie romaine, 06000 Nice, France
| | - N Bronsard
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; Department of Orthopedic Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur & Sport (iULS), University of Côte d'Azur, Hôpital Pasteur 2, 30 Voie romaine, 06000 Nice, France; Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France; UMR E-4320 TIRO-MATOs CEA/DRF/BIAM, University of Côte d'Azur, 28 Avenue de Valombrose, 06107 Nice, France.
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Remy H, Locatelli F, Maertens A, Balaguer T, Baqué P, Bronsard N, Camuzard O. Arterial grafts for proper palmar digital artery reconstruction: An anatomical study. Hand Surg Rehabil 2020; 40:69-74. [PMID: 33137466 DOI: 10.1016/j.hansur.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Digital ischemia due to arterial defects need urgent surgical management. The traditional treatment consists of vascular reconstruction using a reversed autologous venous graft as a bypass. Very few studies have described the use of arterial grafts for digital artery reconstruction. This cadaver study characterized the forearm perforator arteries to assess the potential feasibility of using them as donor grafts for digital artery reconstruction. Eleven forearms and twenty hands were dissected from freshly injected cadavers. All clinically significant perforators (>0.5 mm) derived from radial or ulnar arteries and digital arteries were evaluated. The digital palmar arteries were measured at three points: metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (PIP) joint. In the 11 forearms analyzed, 5.5 ± 1.3 perforators from radial or ulnar arteries with a diameter of at least 0.5 mm were found per dissection. The mean diameters were 0.9 ± 0.18 mm proximally and 0.8 ± 0.15 mm distally; the mean length was 35.6 ± 11.35 mm. The mean diameters for the dominant and non-dominant arteries were 1.5 and 1.3 mm at the MCP, 1.3 and 1.0 mm at the PIP, 0.8 and 0.7 mm at the DIP, respectively. The forearms are good donor sites as they have large-diameter arteries of suitable length for arterial grafting. These new arterial grafts may be suitable for vascular reconstruction of digital arteries starting from the PIP joint.
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Affiliation(s)
- H Remy
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - F Locatelli
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Microchirurgia e Chirurgia della mano, ASST Gaetano Pini-CTO, Università di Milano, Milano, Italia
| | - A Maertens
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - T Balaguer
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - P Baqué
- Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - N Bronsard
- IULS, Service de Traumatologie et d'Orthopédie, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France
| | - O Camuzard
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France.
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Cuerda C, Muscaritoli M, Donini LM, Baqué P, Barazzoni R, Gaudio E, Jezek D, Krznaric Z, Pirlich M, Schetgen M, Schneider S, Vargas JA, Van Gossum A. Nutrition education in medical schools (NEMS). An ESPEN position paper. Clin Nutr 2020; 39:2938-2939. [PMID: 32690431 DOI: 10.1016/j.clnu.2020.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 06/25/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine (Formerly Department of Clinical Medicine), Sapienza University of Rome, Rome, Italy
| | - Lorenzo Maria Donini
- Food Science and Human Nutrition Research Unit, Medical Pathophysiology, Food Science and Endocrinology Section, Experimental Medicine Department, Sapienza University of Rome, Rome, Italy
| | - Patrick Baqué
- School of Medicine, Université Nice-Sophia Antipolis, Université Côté d'Azur, Nice, France
| | - Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical, Health Sciences, Cattinara University Hospital, Trieste, Italy
| | | | - Davor Jezek
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- University Hospital Centre Zagreb, Department of Gastroenterology, Hepatology and Nutrition and Zagreb School of Medicine, Zagreb, Croatia
| | - Matthias Pirlich
- Imperial Oak Outpatient Clinic, Endocrinology, Gastroenterology & Clinical Nutrition, Berlin, Germany
| | - Marco Schetgen
- School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Stephane Schneider
- Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Juan A Vargas
- Internal Medicine. Hospital Universitario Puerta de Hierro de Majadahonda. Universidad Autónoma de Madrid, Madrid, Spain
| | - André Van Gossum
- Department of Gastroenterology and Nutritional Support, Hopital Erasme and Institut Bordet, Free University of Brussels, Brussels, Belgium
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Cuerda C, Muscaritoli M, Donini LM, Baqué P, Barazzoni R, Gaudio E, Jezek D, Krznaric Z, Pirlich M, Schetgen M, Schneider S, Vargas JA, Van Gossum A. Nutrition education in medical schools (NEMS). An ESPEN position paper. Clin Nutr 2019; 38:969-974. [DOI: 10.1016/j.clnu.2019.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/01/2019] [Indexed: 01/25/2023]
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Massalou D, Masson C, Afquir S, Baqué P, Arnoux PJ, Bège T. Influence of gender, age, shelf-life, and conservation method on the biomechanical behavior of colon tissue under dynamic solicitation. Clin Biomech (Bristol, Avon) 2019; 65:34-40. [PMID: 30954683 DOI: 10.1016/j.clinbiomech.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data from biomechanical tissue sample studies of the human digestive tract are highly variable. The aim of this study was to investigate 4 factors which could modify the mechanical response of human colonic specimens placed under dynamic solicitation until tissue rupture: gender, age, shelf-life and conservation method. METHODS We performed uniaxial dynamic tests of human colonic specimens. Specimens were taken according to three different protocols: refrigerated cadavers without embalming, embalmed cadavers and fresh colonic tissue. A total of 143 specimens were subjected to tensile tests, at a speed of 1 m s-1. FINDINGS Young's modulus of the different conservation protocols are as follows: embalmed, 3.08 ± 1.99; fresh, 2.97 ± 2.59; and refrigerated 3.17 ± 2.05. The type of conservation does not modify the stiffness of the tissue (p = 0.26) but does modify the stress necessary for rupture (p < 0.001) and the strain required to obtain lesions of the outer layer and the inner layer (p < 0.001 and p < 0.05, respectively). Gender is also a factor responsible for a change in the mechanical response of the colon. The age of the subjects and the shelf-life of the bodies did not represent factors influencing the mechanical behavior of the colon (p > 0.05). INTERPRETATION The mechanical response of the colon tissue showed a biphasic injury process depending on gender and method of preservation. The age and shelf-life of anatomical subjects do not alter the mechanical response of the colon.
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Affiliation(s)
- D Massalou
- Emergency Surgery Unit, University Hospital of Nice, CHU de Nice Hôpital Pasteur 2, Université de Nice Sophia-Antipolis, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - C Masson
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - S Afquir
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
| | - P Baqué
- Emergency Surgery Unit, University Hospital of Nice, CHU de Nice Hôpital Pasteur 2, Université de Nice Sophia-Antipolis, France.
| | - P-J Arnoux
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - T Bège
- Department of Visceral Surgery, AP-HM Hôpital Nord, Aix-Marseille University, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
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Hufschmidt K, Camuzard O, Balaguer T, Baqué P, de Peretti F, Santini J, Bronsard N, Qassemyar Q. The infraorbital artery: From descriptive anatomy to mucosal perforator flap design. Head Neck 2019; 41:2065-2073. [PMID: 30684276 DOI: 10.1002/hed.25653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction. METHODS Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery's characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction. RESULTS We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of ≥0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections. CONCLUSION The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.
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Affiliation(s)
- Katharina Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Olivier Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Thierry Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Patrick Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Nice, France
| | - Fernand de Peretti
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Joseph Santini
- Department of Head and Neck Surgery, University Hospital of Nice, Nice, France
| | - Nicolas Bronsard
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Quentin Qassemyar
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Tenon, Paris, France
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Hufschmidt K, Bronsard N, Foissac R, Baqué P, Balaguer T, Chignon-Sicard B, Santini J, Camuzard O. The infraorbital artery: Clinical relevance in esthetic medicine and identification of danger zones of the midface. J Plast Reconstr Aesthet Surg 2018; 72:131-136. [PMID: 30327185 DOI: 10.1016/j.bjps.2018.09.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/20/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over the past decade, cosmetic injections of dermal fillers or fat have become a popular procedure in facial rejuvenation in an overconsuming society. However, complications such as arterial embolism and occlusion can occur even with experienced injectors, especially in high-risks zones namely the glabella, the nasal dorsum or the nasolabial fold. The aim of this study was to define the vascular danger zones of the infraorbital area in order to provide guidelines helping avoid them. MATERIALS AND METHODS The infraorbital artery, its main branches and their anastomoses with neighbouring vessels were studied in 18 fresh cadavers. Mimetic injections of inked hyaluronic acid were performed in the infraorbital area in the interest of analyzing its distribution and to determine potential vascular risks towards the infraorbital artery and its branches. RESULTS The infraorbital artery and its branches were located in common injection regions and anastomosed to the supratrochlear artery, the dorsal nasal artery and the angular artery through the nasal branch of the infraorbital artery. Two danger zones could be depicted: injections can be risky when performed too superficially in the midcheek area, and likewise risky when performed in a periosteal layer in infraorbital hollow or tear-trough correction, because of an obvious possibility of retrograde embolism. CONCLUSION The infraorbital artery can be involved in anatomic mechanism of arterial occlusion, further blindness and stroke, among the related neighbouring arteries. Based on the findings of this study, injections to the periosteum layer in tear-trough correction and above the periosteum on the zygomatic arch is not advised.
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Affiliation(s)
- K Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France.
| | - N Bronsard
- Institut Universitaire Locomoteur et Sport (iULS), Hôpital Pasteur 2, University of Nice Sophia Antipolis (UNSA), Nice, France
| | - R Foissac
- Unit of Plastic and Esthetic Surgery, Clinic Saint George, 2 avenue de Rimiez, 06105 Nice, France
| | - P Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - T Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - B Chignon-Sicard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
| | - J Santini
- Head and Neck Institute, University Hospital of Nice, 31, avenue de Valombrose, 06000 Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Pasteur 2, 30, avenue de la Voie Romaine, 06000 Nice, France
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Massalou D, Masson C, Foti P, Afquir S, Baqué P, Berdah SV, Bège T. Dynamic biomechanical characterization of colon tissue according to anatomical factors. J Biomech 2016; 49:3861-3867. [PMID: 27789033 DOI: 10.1016/j.jbiomech.2016.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 10/13/2016] [Accepted: 10/16/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The aim of this study was to determine the mechanical response of colonic specimens retrieved from the entire human colon and placed under dynamic solicitation until the tissue ruptured. MATERIAL AND METHODS Specimens were taken from 20 refrigerated cadavers from different locations of the colonic frame (ascending, transverse, descending and sigmoid colon) in two different directions (longitudinal and circumferential), with or without muscle strips (taenia coli). A total of 120 specimens were subjected to tensile tests, after preconditioning, at the speed of 1m/s. RESULTS High-speed video analysis showed a bilayer injury process with an initial rupture of the serosa / external muscular layer followed by a second rupture of the inner layer consisting of the internal muscle / submucosa / mucosa. The mechanical response was biphasic, with a first point of initial damage followed by a complete rupture. The levels of stress and strain at the failure site were statistically greater in terms of circumferential stress (respectively 69±22% and 1.02±0.50MPa) than for longitudinal stress (respectively 55±32% and 0.70±0.34MPa). The difference between longitudinal and circumferential stress was not statistically significant (3.17±2.05MPa for longitudinal stress and 3.15±1.73MPa for circumferential stress). The location on colic frame significantly modified the mechanical response both longitudinally and circumferentially, whereas longitudinal taenia coli showed no mechanical influence. CONCLUSION The mechanical response of the colon specimen under dynamic uniaxial solicitation showed a bilayer and biphasic injury process depending on the direction of solicitation and colic localization. Furthermore these results could be integrated into a numeric model reproducing abdominal trauma to better understand and prevent intestinal injuries.
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Affiliation(s)
- D Massalou
- Emergency Surgery Unit, Universitary Hospital of Nice, Hôpital Pasteur 2, Nice Sophia-Antipolis University, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - C Masson
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
| | - P Foti
- Emergency Surgery Unit, Universitary Hospital of Nice, Hôpital Pasteur 2, Nice Sophia-Antipolis University, France
| | - S Afquir
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
| | - P Baqué
- Emergency Surgery Unit, Universitary Hospital of Nice, Hôpital Pasteur 2, Nice Sophia-Antipolis University, France
| | - S-V Berdah
- Department of Visceral Surgery, AP-HM Hôpital Nord, Aix-Marseille University, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
| | - T Bège
- Department of Visceral Surgery, AP-HM Hôpital Nord, Aix-Marseille University, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
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Affiliation(s)
- Katharina Hufschmidt
- Department of Reconstructive and Plastic Surgery, University Hospital Nice, Pasteur 2, Nice, France
| | - Laurent Hekayem
- Department of General and Emergency Medicine, University Hospital Nice, Pasteur 2, Nice, France
| | - Patrick Baqué
- Department of General and Digestive Surgery, University Hospital Nice, Pasteur 2, Nice, France
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Camuzard O, Foissac R, Clerico C, Fernandez J, Balaguer T, Ihrai T, de Peretti F, Baqué P, Boileau P, Georgiou C, Bronsard N. Inferior Cubital Artery Perforator Flap for Soft-Tissue Coverage of the Elbow: Anatomical Study and Clinical Application. J Bone Joint Surg Am 2016; 98:457-65. [PMID: 26984913 DOI: 10.2106/jbjs.o.00760] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Soft-tissue defects surrounding the elbow can be a challenging problem for the orthopaedic surgeon. Reliable reconstruction with use of muscular flaps or even perforator flaps derived from the surrounding vessels has been described. The inferior cubital artery (ICA) is an indirect septocutaneous perforator branch that most frequently arises from the lateral side of the radial artery. The purposes of the present study were to characterize the capillary cutaneous perforators of the ICA and to evaluate the potential of a local perforator flap procedure for soft-tissue coverage of the elbow. METHODS Twenty fresh cadaveric forearms were dissected in order to describe the ICA anatomy, and in ten additional forearms the ICA was selectively injected with a red ink solution to detail the ICA vascular territory. For each artery, we recorded the site of origin, the diameter of the artery at its source, the course of the artery, and the number, type, and diameter of capillary cutaneous perforators. RESULTS A total of seventy-eight ICA capillary perforators were analyzed from the twenty dissected forearms: forty-six were in-transit capillary perforators, nineteen were terminal capillary perforators, and thirteen were musculocutaneous capillary perforators. Of these seventy-eight perforators, sixteen (21%) had a caliber of <0.5 mm and sixty-two capillary perforators (79%) had a caliber of ≥0.5 mm. Ten ICAs were selectively injected, and the mean size of all stained skin areas was 30.9 ± 11.9 cm(2). A perforator pedicled flap was readily feasible for all dissections. We also describe the case of a patient with a medial soft-tissue defect of the elbow that was covered with a pedicled perforator flap based on an ICA. The patient had satisfactory healing at two months. CONCLUSIONS The ICA flap is a reliable and useful flap for elbow soft-tissue reconstruction. CLINICAL RELEVANCE The perforator flap procedure is a major advancement in reconstructive surgery. One potential application of the perforator flaps is the use of tissue adjacent to a defect as a perforator-based island flap. The use of this tissue allows for thinner flaps to be tailored for more accurate reconstruction. A flap that depends on a perforator branch of the radial artery called the inferior cubital artery seems to be an excellent solution for soft-tissue coverage of the elbow.
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Affiliation(s)
- Olivier Camuzard
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France UMR E-4320 MATOs CEA/iBEB/SBTN-CAL, Université Nice Sophia Antipolis, Faculté de Médecine, Nice, France
| | - Rémi Foissac
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Cyril Clerico
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Jonathan Fernandez
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Thierry Balaguer
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Tarik Ihrai
- Service de Chirurgie Oncologique Réparatrice, CAL, Nice, France
| | - Fernand de Peretti
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
| | - Patrick Baqué
- Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
| | - Pascal Boileau
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Charalambos Georgiou
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France
| | - Nicolas Bronsard
- Service de Chirurgie Réparatrice et de la Main (O.C., R.F., C.C., J.F., T.B., C.G.), Service de Traumatologie (F.de P., N.B.), and Service d'Orthopédie (P.B.), CHU de Nice, Nice, France Laboratoire d'Anatomie Humaine, Faculté de Médecine de Nice, Nice, France
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Massalou D, Bège T, Masson C, Foti P, Arnoux PJ, Baqué P, Brunet C, Berdah SV. Biomechanical response of colonic tissue under high-speed traction. Comput Methods Biomech Biomed Engin 2015; 18:1998-1999. [PMID: 26241078 DOI: 10.1080/10255842.2015.1069592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- D Massalou
- a Emergency Surgery Unit , Universitary Hospital of Nice, Nice Sophia-Antipolis University , Nice , France.,b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France
| | - T Bège
- b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France.,c Department of Visceral Surgery , AP-HM, Aix-Marseille University , Marseille , France
| | - C Masson
- b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France
| | - P Foti
- a Emergency Surgery Unit , Universitary Hospital of Nice, Nice Sophia-Antipolis University , Nice , France
| | - P-J Arnoux
- b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France
| | - P Baqué
- a Emergency Surgery Unit , Universitary Hospital of Nice, Nice Sophia-Antipolis University , Nice , France
| | - C Brunet
- b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France.,c Department of Visceral Surgery , AP-HM, Aix-Marseille University , Marseille , France
| | - S-V Berdah
- b Biomechanical Applied Laboratory, UMRT24, IFSTTAR , Aix-Marseille University , Marseille , France.,c Department of Visceral Surgery , AP-HM, Aix-Marseille University , Marseille , France
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Massalou D, Chetrus-Mariage D, Baqué P. York-Mason repair of recto-urethral fistula. J Visc Surg 2015; 152:185-8. [PMID: 25862383 DOI: 10.1016/j.jviscsurg.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D Massalou
- UCSU chirurgie, pôle urgences SAMU-SMUR, hôpital Saint-Roch, CHU de Nice, université Nice Sophia-Antipolis, 5, rue Pierre-Devoluy, CS 91179, 06001 Nice cedex 1, France; Laboratoire de biomécanique appliquée, UMRT24, IFSTTAR, Aix-Marseille université, boulevard Pierre-Dramard, 13000 Marseille, France.
| | - D Chetrus-Mariage
- UCSU chirurgie, pôle urgences SAMU-SMUR, hôpital Saint-Roch, CHU de Nice, université Nice Sophia-Antipolis, 5, rue Pierre-Devoluy, CS 91179, 06001 Nice cedex 1, France
| | - P Baqué
- UCSU chirurgie, pôle urgences SAMU-SMUR, hôpital Saint-Roch, CHU de Nice, université Nice Sophia-Antipolis, 5, rue Pierre-Devoluy, CS 91179, 06001 Nice cedex 1, France
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Duarte S, Momier D, Baqué P, Casanova V, Loubat A, Samson M, Guigonis JM, Staccini P, Saint-Paul MC, De Lima MP, Carle GF, Pierrefite-Carle V. Preventive cancer stem cell-based vaccination reduces liver metastasis development in a rat colon carcinoma syngeneic model. Stem Cells 2014. [PMID: 23193035 DOI: 10.1002/stem.1292] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cancer stem cells (CSCs) represent a minor population of self-renewing cancer cells that fuel tumor growth. As CSCs are generally spared by conventional treatments, this population is likely to be responsible for relapses that are observed in most cancers. In this work, we analyzed the preventive efficiency of a CSC-based vaccine on the development of liver metastasis from colon cancer in a syngeneic rat model. We isolated a CSC-enriched population from the rat PROb colon carcinoma cell line on the basis of the expression of the aldehyde dehydrogenase-1 (ALDH1) marker. Comparative analysis of vaccines containing lysates of PROb or ALDH(high) cells by mass spectrometry identifies four proteins specifically expressed in the CSC subpopulation. The expression of two of them (heat shock protein 27-kDa and aldose reductase) is already known to be associated with treatment resistance and poor prognosis in colon cancer. Preventive intraperitoneal administration of vaccines was then performed before the intrahepatic injection of PROb cancer cells. While no significant difference in tumor occurrence was observed between control and PROb-vaccinated groups, 50% of the CSC-based vaccinated animals became resistant to tumor development. In addition, CSC-based vaccination induced a 99.5% reduction in tumor volume compared to the control group. To our knowledge, this study constitutes the first work analyzing the potential of a CSC-based vaccination to prevent liver metastasis development. Our data demonstrate that a CSC-based vaccine reduces efficiently both tumor volume and occurrence in a rat colon carcinoma syngeneic model.
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Affiliation(s)
- Sonia Duarte
- CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
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Massalou D, Fournier M, Salucki B, Baqué P. Small bowel obstruction secondary to transport aircraft: coincidence or reality? Clin Res Hepatol Gastroenterol 2013; 37:434-6. [PMID: 23806628 DOI: 10.1016/j.clinre.2013.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 02/04/2023]
Abstract
Small bowel obstructions (SBO) are a leading cause of admission to general surgery, posing the problem of the aetiology and treatment based on the diagnosis. More than 300 patients were admitted for SBO in 2011 in our institution. In our clinical practice, we have had to care for patients with SBO immediately after air travel, all of whom had an antecedent of abdominal surgery by laparotomy. The finding of episodes of acute SBO immediately following a commercial flight has never been reported in the literature. We report the cases of four patients for whom we offer several pathophysiological hypotheses, and we publish the first dietary rules for people with a history of intraperitoneal surgery to adopt during a flight.
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Affiliation(s)
- D Massalou
- Acute care surgery unit, St Roch Hospital, University Hospital of Nice, University of Nice Sophia-Antipolis, Nice, France.
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19
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Massalou D, Bège T, Masson C, Bourgouin S, Foti P, Arnoux PJ, Baqué P, Brunet C, Berdah SV. Influence of loading speed on the mechanical properties of the colon. Comput Methods Biomech Biomed Engin 2013; 16 Suppl 1:189-90. [PMID: 23923903 DOI: 10.1080/10255842.2013.815876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- D Massalou
- Emergency Surgery Unit, UCSU Chirurgie, Hôpital St Roch, CHU de Nice, Université de Nice Sophia-Antipolis, Nice, France.
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Bréaud J, Montoro J, Lecompte JF, Valla JS, Loeffler J, Baqué P, Brunet C, Thollon L. Posterior urethral injuries associated with motorcycle accidents and pelvic trauma in adolescents: analysis of urethral lesions occurring prior to a bony fracture using a computerized finite-element model. J Pediatr Urol 2013; 9:62-70. [PMID: 22204757 DOI: 10.1016/j.jpurol.2011.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/03/2011] [Indexed: 10/14/2022]
Abstract
UNLABELLED Adolescent males involved in motorcycle accidents are particularly at risk for pelvic injury, which may provoke a posterior urethral injury. The aim of this study was to develop a model to analyze the association between injuries and fractures of the pelvic ring and the risk of posterior urethral injury. METHOD Based on experience with traffic accident modeling, a computerized finite-element model was extrapolated from a computerized tomography scan of a 15-year-old boy. The anatomic structures concerned in urethral and pelvic ring trauma were isolated, rendered in 3D and given biomechanical properties. The model was verified according to available experiments on pelvic ring trauma. RESULTS To apply the model, we recreated three impact mechanisms on the pelvic ring: lateral impact, antero-posterior impact and a real car‒motorcycle accident situation (postero-lateral impact). In all three situations, stretching of the posterior urethra was identified prior to bony fracture visualization. CONCLUSION Application of this model allowed us to analyze precisely the link between trauma of the pelvic ring and lesions of the posterior urethra. The results should help to establish guidelines for urethral catheterization in male adolescents in cases of pelvic trauma, even when no bony fracture is present, in order to prevent iatrogenic worsening of a misdiagnosed posterior urethral trauma.
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Affiliation(s)
- J Bréaud
- Service de Chirurgie Infantile, Hôpitaux Pédiatriques de Nice, France.
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Massalou D, Baqué-Juston M, Foti P, Staccini P, Baqué P. CT quantification of hemoperitoneum volume in abdominal haemorrhage: a new method. Surg Radiol Anat 2012; 35:481-6. [DOI: 10.1007/s00276-012-1057-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 12/07/2012] [Indexed: 11/29/2022]
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Bréaud J, Baqué P, Loeffler J, Colomb F, Brunet C, Thollon L. Posterior urethral injuries associated with pelvic injuries in young adults: computerized finite element model creation and application to improve knowledge and prevention of these lesions. Surg Radiol Anat 2011; 34:333-9. [PMID: 22116405 DOI: 10.1007/s00276-011-0900-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 11/07/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Young adult males involved in motorcycle accidents are particularly at risk for posterior urethral injury whenever pelvic injury occurs. Posterior urethral injuries remain problematic because their diagnosis may be missed, and during the initial treatment response the urethral injury can be aggravated by urethral catheterization. Few anatomical and clinical tools exist that establish a correlation between injuries and fractures of the pelvic ring and the risk of posterior urethral injury. METHOD Based on experience with traffic accident modeling, a computerized finite element model was conceived integrating the specific anatomic structures concerned. This model was extrapolated from a CAT scan of a young adult. The anatomic structures concerned in urethral and pelvic ring trauma (PRT) were isolated, placed in 3D and given biomechanical properties. The model was verified according to available experiments on PRT. RESULTS To apply the model, we recreated a lateral impact mechanism on the pelvic ring. Stretching between the prostatic and membranous portions of the urethra (before and after visualization of a pelvic fracture) as well as timing of injury was studied. CONCLUSION The model's application permitted us to analyze precisely the link between lateral impact trauma of the pelvic ring and lesions of the posterior urethra and to identify an urethra stretching prior to visualization of a pelvic fracture. Utilization of the model with other mechanisms of injury should allow for better comprehension of this associated trauma, improved prevention, iatrogenic aggravation of, and care for, these serious injuries.
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Affiliation(s)
- J Bréaud
- Service de Chirurgie Infantile, Hôpitaux Pédiatriques de Nice, 57 avenue de la Californie, 06200 Nice, France.
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Abstract
Necrotizing soft-tissue infections (NSTIs) are acute surgical conditions that demand prompt and multi-faceted treatment. Early recognition, appropriate resuscitation measures, aggressive surgical debridement, and targeted antimicrobial therapy significantly affect the overall outcome and survival of NSTI patients. Necrotizing fasciitis refers to a particular type of NSTI, where necrosis of the skin, subcutaneous tissue and fascia is predominant and there is very little muscle involvement. A 51-year-old woman presented with necrotizing fasciitis of the abdominal wall following colostomy for obstructive colon carcinoma. In this particular case, stoma relocation was necessary because of the need for large parietal surgical debridement.
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Affiliation(s)
- D. Massalou
- UHCD Chirurgie, Pôle Urgences adultes-SAMU-SMUR, Hôpital St Roch, CHU de Nice, Nice, France; UFR Médecine Nice, Université Nice Sophia-Antipolis
| | - P. Baqué
- UHCD Chirurgie, Pôle Urgences adultes-SAMU-SMUR, Hôpital St Roch, CHU de Nice, Nice, France; UFR Médecine Nice, Université Nice Sophia-Antipolis
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Masson C, Baqué P, Brunet C. Biomechanical response of impacted bony pelvis: influence of the morphometry and bone density. Comput Methods Biomech Biomed Engin 2010; 13:641-6. [DOI: 10.1080/10255840903446953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baqué P, Iannelli A, Delotte J, de Peretti F, Bourgeon A. Division of the right posterior attachments of the head of the pancreas with a linear stapler during pancreaticoduodenectomy: vascular and oncological considerations based on an anatomical cadaver-based study. Surg Radiol Anat 2008; 31:13-7. [DOI: 10.1007/s00276-008-0353-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Accepted: 04/24/2008] [Indexed: 02/05/2023]
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Bertin S, Samson M, Pons C, Guigonis JM, Gavelli A, Baqué P, Brossette N, Pagnotta S, Ricci JE, Pierrefite-Carle V. Comparative proteomics study reveals that bacterial CpG motifs induce tumor cell autophagy in vitro and in vivo. Mol Cell Proteomics 2008; 7:2311-22. [PMID: 18632594 DOI: 10.1074/mcp.m800100-mcp200] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Unmethylated CpG dinucleotides, present in bacterial DNA, are recognized in vertebrates via the Toll-like receptor 9 (TLR9) and are known to act as an anticancer agent by stimulating immune cells to induce a proinflammatory response. Although the effects of CpG-oligodeoxynucleotides (CpG-ODNs) in immune cells have been widely studied, little is known regarding their molecular effects in TLR9-positive tumor cells. To better understand the role of these bacterial motifs in cancer cells, we analyzed proteome modifications induced in TLR9-positive tumor cells in vitro and in vivo after CpG-ODN treatment in a rat colon carcinoma model. Proteomics analysis of tumor cells by two-dimensional gel electrophoresis followed by mass spectrometry identified several proteins modulated by bacterial CpG motifs. Among them, several are related to autophagy including potential autophagic substrates. In addition, we observed an increased glyceraldehyde-3-phosphate dehydrogenase expression, which has been shown to be sufficient to trigger an autophagic process. Autophagy is a self-digestion pathway whereby cytoplasmic material is sequestered by a structure termed the autophagosome for subsequent degradation and recycling. As bacteria are known to trigger autophagy, we assessed whether bacterial CpG motifs might induce autophagy in TLR9-positive tumor cells. We showed that CpG-ODN can induce autophagy in rodent and human tumor cell lines and was TLR9-dependent. In addition, an increase in the number of autophagosomes can also be observed in vivo after CpG motif intratumoral injection. Our findings bring new insights on the effect of bacterial CpG motifs in tumor cells and may be relevant for cancer treatment and more generally for gene therapy approaches in TLR9-positive tissues.
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Bertin S, Neves S, Gavelli A, Baqué P, Brossette N, Simões S, Pedroso de Lima MC, Pierrefite-Carle V. Cellular and molecular events associated with the antitumor response induced by the cytosine deaminase/5-fluorocytosine suicide gene therapy system in a rat liver metastasis model. Cancer Gene Ther 2007; 14:858-66. [PMID: 17589431 DOI: 10.1038/sj.cgt.7701075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The bacterial cytosine deaminase (CD) gene converts the non-toxic prodrug 5-fluorocytosine (5-FC) into 5-fluorouracil. We have previously shown, in a rat liver metastasis model from colon carcinoma, that intratumoral injection of a CD-expressing plasmid into the animals followed by 5-FC treatment results in the regression of the treated tumor as well as distant uninjected tumors. The aim of this study was to further analyze the mechanisms associated with tumor regression induced upon application of suicide CD/5-FC strategy. Tumor regression was associated with an increased apoptosis, the recruitment of natural killer cells, CD4- and CD8 T lymphocytes within the tumors and an increased expression of several cytokines/chemokines mRNAs. These data indicate that the CD/5-FC suicide strategy is associated with the triggering of cellular and molecular events leading to an efficient antitumor immune response involving both innate and acquired immunity.
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MESH Headings
- Animals
- Antimetabolites/therapeutic use
- Apoptosis
- CD4-Positive T-Lymphocytes/immunology
- CD8-Positive T-Lymphocytes/immunology
- Colorectal Neoplasms/immunology
- Colorectal Neoplasms/pathology
- Combined Modality Therapy
- Cytokines/genetics
- Cytosine Deaminase/genetics
- Flucytosine/therapeutic use
- Gene Expression Regulation, Enzymologic/physiology
- Genes, Transgenic, Suicide
- Genetic Therapy
- Killer Cells, Natural/immunology
- Liposomes
- Liver Neoplasms, Experimental/immunology
- Liver Neoplasms, Experimental/secondary
- Liver Neoplasms, Experimental/therapy
- Male
- Plasmids/pharmacology
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Rats
- Rats, Inbred Strains
- Transfection
- Tumor Cells, Cultured
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Baqué P, Serre T, Cheynel N, Arnoux PJ, Thollon L, Behr M, Masson C, Delotte J, Berdah SV, Brunet C. An Experimental Cadaveric Study for a Better Understanding of Blunt Traumatic Aortic Rupture. ACTA ACUST UNITED AC 2006; 61:586-91. [PMID: 16966992 DOI: 10.1097/01.ta.0000197423.11405.e3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Blunt traumatic aortic rupture (BTAR) is a common catastrophic injury leading to death. Considerable uncertainty remains regarding the pathogenic cause. This study examines the comportment of the heart and the aorta during a frontal deceleration. METHODS Accelerometers were placed in the right ventricle of the heart, the aorta, the sternum, and the spine of six trunks removed from human cadavers. Different vertical decelerations were applied to cadavers and the relative motion of these organs was studied (19 tests). RESULTS The deceleration recorded in the isthmus of the aorta was always higher that the one recorded in the heart (p < 0.05). The difference of deceleration was 17% and increased with the speed's fall (extremes 5-25%). There was no significant difference of deceleration between the bony structures of the thorax. These results experimentally demonstrate for the first time that the fundamental mechanism of BTAR is sudden stretching of the isthmus of the aorta. CONCLUSION Four mechanisms are suspected to explain the location of the rupture: two hemodynamic mechanism (sudden increase of intravascular pressure and the water-hammer effect), and two physical mechanisms (sudden stretching of the isthmus and the osseous pinch). A greater understanding of the mechanism of this injury could improve vehicle safety leading to a reduction in its incidence and severity. Future work in this area should include the creation of an inclusive, dynamic model of computer-based modeling systems. This study provides for the first time physical demonstration and quantification of the stretching of the isthmus, leading to a computerized model of BTAR.
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Affiliation(s)
- Patrick Baqué
- Laboratoire de Biomécanique appliquée, INRETS-UMTR, Faculté de Médecine Nord, Marseille, France.
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Baqué P, Trojani C, Delotte J, Séjor E, Senni-Buratti M, de Baqué F, Bourgeon A. Anatomical consequences of “open-book” pelvic ring disruption. A cadaver experimental study. Surg Radiol Anat 2005; 27:487-90. [PMID: 16311717 DOI: 10.1007/s00276-005-0027-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 06/13/2005] [Indexed: 11/24/2022]
Abstract
UNLABELLED "Open-book" pelvic fractures associate a diastasis and/or a fracture of the pubic rami with a posterior pelvic disruption of the sacro-iliac joint. These uni or bilateral lesions are potentially lethal mainly due to associated injuries and massive pelvic hemorrhage. The most frequently injured arteries are parietal branch of the commune, internal or external arteries because of their proximity to the bone, the sacro-iliac joint and the inferior ligaments of the pelvis. The pelvic bone dislocation and the increase of pelvic volume facilitate blood effusion. The aim of this study was to determine, on a cadaver fracture model, the direct anatomical consequences of "open-book" pelvic fracture on the ilio-lumbar pedicle and the pelvic cavity volume. MATERIALS AND METHODS Bilateral open-book pelvic ring injuries were created in ten non-embalmed cadaver specimens by directly disrupting the pubic symphysis, the right and the left sacro-iliac joints. Pelvic volume was determined after total pelvic exenteration. Consequences of this fracture on vascular parietal network, nervous pelvic trunk and pelvic cavity volume were studied. RESULTS The mean volume of the pelvic cavity after complete visceral exenteration was 872.5 cm(3) (extremes 580-756 cm(3)). The average increase of pelvic volume was 20.8% after 5 cm of pubic diastasis. In all cases, because of a transversal disposition of the ilio-lumbar pedicle with regard to the sacro-iliac joint, reproduction of the open-book fracture caused a venous dilaceration of the ilio-lumbar vein in 12 cases after 5 cm of pubic diastasis (12/20=60%). No arterial dilaceration was observed on the ilio-lumbar artery, but this artery was put in tension. CONCLUSION Open-book fractures create an increase of pelvic volume that facilitates blood diffusion from parietal pelvic vascular network. Ilio-lumbar pedicle seems to be very vulnerable in this type of fracture because of its relations to the sacro-iliac joint and its transversal disposition with regard to this joint.
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Affiliation(s)
- Patrick Baqué
- Faculté de Médecine de Nice, Institut d'Anatomie Normale, Avenue de Vallombrose, 06000, Nice, Cedex 3, France.
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Abstract
In the last decade, laparoscopic gastric banding has become an increasingly popular surgical option for morbidly obese patients, because of the minimally invasive and easy surgical technique, its reversibility, and the possibility to calibrate the stoma. Gastric necrosis, as a complication of laparoscopic gastric banding, has been only rarely reported. Herein described is the case of a 45-year-old obese patient with gastric necrosis occurring 2 years after the placement of the band. After initial conservative management, the patient underwent urgent surgery. A huge anterior gastric prolapse through the band was found to be responsible for necrosis of the herniated stomach. An upper polar gastrectomy was performed. The mechanisms responsible for this life-threatening complication are discussed.
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Affiliation(s)
- Antonio Iannelli
- Service de Chirurgie Digestive et Transplantation Hépatique, Nice, France.
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Baqué P, Iannelli A, Dausse F, de Peretti F, Bourgeon A. A new method to approach exact hemoperitoneum volume in a splenic trauma model using ultrasonography. Surg Radiol Anat 2005; 27:249-53. [PMID: 15834505 DOI: 10.1007/s00276-004-0307-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2004] [Accepted: 10/25/2004] [Indexed: 11/29/2022]
Abstract
In the trauma setting, the Focused Assessment for the Sonographic examination of the Trauma patient (FAST) accurately detects hemoperitoneum. Currently, only an approximate evaluation of the volume of free intraperitoneal fluid (FIPF) can be done by imaging modalities such as ultrasound (US). The aim of this study was to correlate the thickness of FIPF measured by US in different sites of the peritoneal cavity with the total volume of an experimental post-traumatic hemoperitoneum. An intra-abdominal collection with ongoing bleeding was simulated in eight cadavers with no previous abdominal surgery. Between 200 and 2000 ml of saline solution was instilled into the left hypochondrium of eight non-embalmed cadavers. During the instillation, FIPF thickness was measured every 200 ml by US in six different declivous sites of the peritoneal cavity. The volume of FIPF instilled could be mathematically correlated with fluid thickness in all the sites through the linear equation Y=aX+b, where Y is the volume of FIPF in milliliters, a is 33 (variability coefficient), X is the FIPF thickness in millimeters and b is 470 ml (minimum volume detectable by US). The best correlation between thickness and volume was obtained in the hepatorenal pouch (Morrison pouch). Evaluation of the impact of intraperitoneal hemorrhage on the hemodynamic state of spleen trauma patients is of paramount importance for the surgeon, who has to decide whether to perform a laparotomy for hemostasis or not, specially when intra- and extra-abdominal injuries conjointly exist. After clinical validation, this new method to calculate the exact volume of FIPF could be used in current clinical practice of abdominal trauma to assist in the decision-making regarding non-operative treatment of spleen trauma.
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Affiliation(s)
- Patrick Baqué
- Institut d'Anatomie Normale, Faculté de Médecine de Nice, Avenue de Vallombrose, 06107 Nice cedex 2, France.
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Baqué P, Chevallier P, Karimdjee Solihi F, Rahili MA, Iannelli A, Benizri EI, Bernard JL, Bereder JM, Oddo F, Padovani B, Gugenheim J, Benchimol D, Bourgeon A. [Colostomy vs self-expanding metallic stents: comparison of the two techniques in acute tumoral left colonic obstruction]. ACTA ACUST UNITED AC 2004; 129:353-8. [PMID: 15297225 DOI: 10.1016/j.anchir.2004.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2003] [Accepted: 04/21/2004] [Indexed: 11/26/2022]
Abstract
UNLABELLED Self-expanding metallic stents is an alternative treatment to colostomy that is the treatment of choice in acute tumoral left colonic obstruction. AIM OF THE STUDY To compare morbidity, mortality, length of hospital stay and treatment performed after desobstruction using the two methods. PATIENTS AND METHODS Thirty-three patients admitted for acute obstruction of the left colon were retrospectively separated in two groups depending on the type of intervention performed to treat the obstruction ("colostomy" group: 17 patients and "self-expanding stent group": 16 patients). We studied complications after desobstruction, hospital courses and surgical strategy performed after the acute phase. RESULTS Time between desobstruction and colectomy was shorter in the "self-expanding stent group" than in the "colostomy group" (18.5 days versus 73 days). Age superior than 75 years and colostomy were the two main factors predicting the risk of definitive colostomy (P < 0.05). Global mean hospital stay was longer in the colostomy group (32.7 days versus 19.3 days, P = 0.02). Two perforations and one local recurrence occurred in the "self-expanding stent group". CONCLUSIONS Self-expanding metallic stent can decrease the permanent colostomy rate and the number of interventions. The recurrence rate seems to be theoretically increased with the stenting method. Then, colostomy must be done for patients in curative situation. The self-expanding metallic stent should be used as a palliative care.
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Affiliation(s)
- P Baqué
- Service de chirurgie générale et cancérologie digestive (Pr A. Bourgeon), hopital l'Archet II, 151 route de Saint-Antoine de Ginestière, BP 3079, Nice cedex 3, France.
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Baqué P, Karimdjee B, Iannelli A, Benizri E, Rahili A, Benchimol D, Bernard JL, Sejor E, Bailleux S, de Peretti F, Bourgeon A. Anatomy of the presacral venous plexus: implications for rectal surgery. Surg Radiol Anat 2004; 26:355-8. [PMID: 15300413 DOI: 10.1007/s00276-004-0258-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The presacral venous plexus results from anastomoses between the lateral and median sacral veins, and courses into the pelvic fascia covering the anterior aspect of the body of the sacrum. The presacral venous plexus is not directly visible during rectal surgery, and injuries to this plexus may be life-threatening. Dissection of the retrorectal plane or anchoring of the rectum to the sacral promontory as in rectal prolapse surgery exposes the patient to the risk of injury to the presacral venous plexus. The aim of this study was to identify some avascular areas in the anterior aspect of the sacrum in order to lower the occurrence of such injuries during rectal surgery. The pelvis of 10 fresh cadavers was dissected after injection of a colored resin into the inferior vena cava, and the presacral venous plexus was studied. Four avascular tetragonal areas were common to all the specimens. The corners of a square with a side of 3 cm, centered on the anterior aspect of the body of sacrum, were always contained in the avascular areas. The upper side of this square was parallel to a line passing through the sacral promontory, at a 3 cm distance from it. Staples or sutures should be placed in the avascular areas to avoid injuries to the presacral venous plexus.
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Affiliation(s)
- P Baqué
- Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, 06000 Nice, France.
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Gavelli A, Baqué P, Brossettej N, Bourgeon A, Staccini P, Rossi B, Pierrefite-Carle V. Per os administration of 5-fluorocytosine is effective in the regression of CD-expressing liver metastases in rats. Int J Mol Med 2004; 14:323-5. [PMID: 15254786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The bacterial cytosine deaminase (CD) gene, associated to the 5-fluorocytosine (5-FC) prodrug, is one of the more widely used suicide systems in gene therapy. Introduction of the CD gene within a tumor induces, after 5-FC treatment of the animal, a local production of 5-fluorouracil (5-FU) resulting in intratumor chemotherapy. Destruction of the gene-modified tumor is then followed by the triggering of an anti-tumor immune reaction resulting in the regression of distant wild-type metastasis. In pre-clinical studies, 5-FC is generally administered by daily intraperitoneal injections. However, when used as an anti-fungal in humans, either IV or oral administration is used. In this study, we compared oral and intraperitoneal 5-FC administration in rats bearing a wild-type and a cytosine deaminase-expressing liver tumors. The results indicate that per os 5-FC administration is as efficient as intraperitoneal for the induction of CD-expressing tumor regression and the triggering of a distant bystander effect, acting on wild-type liver tumor and extra-hepatic metastasis.
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Affiliation(s)
- Adolfo Gavelli
- Unité INSERM 364, Faculté de Médecine, 06107 Nice cédex 2, France
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Gavelli A, Baqué P, Brossettej N, Bourgeon A, Staccini P, Rossi B, Pierrefite-Carle V. Per os administration of 5-fluorocytosine is effective in the regression of CD-expressing liver metastases in rats. Int J Mol Med 2004. [DOI: 10.3892/ijmm.14.2.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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36
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Yiming A, Baqué P, Rahili A, Mayer J, Braccini AL, Fontaine A, Leplatois A, Clavé A, Bourgeon A, de Peretti F. Anatomical study of the blood supply of the coxal bone: radiological and clinical application. Surg Radiol Anat 2002; 24:81-6. [PMID: 12197024 DOI: 10.1007/s00276-002-0029-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this work was to study the arterial blood supply of the coxal bone in order to optimize radiological embolization and to minimize the risk of postoperative osteonecrosis. Ten fresh cadavers were dissected after intra-arterial injection of colored resin. All the collateral vessels running to this bone were described and counted. On 25 dry bones, the vascular foramina were measured with the aid of a millimetric gauge and a vascular map was created. The posterior part of the ilium appears to be twice as well vascularized as the anterior part. Fractures of the posterior arch of the pelvis are theoretically more hemorrhagic. The presence of the iliolumbar artery in contact with the sacroiliac joint increases the risk with open book or shearing fractures. The artery of the ischium, a collateral of the pudendal artery, supplies the posterior and lateral parts of the acetabulum and the artery of the roof of the acetabulum, its superior and lateral parts. The branches of the anterior and posterior divisions of the obturator artery supply the superior part of the surroundings of the obturator foramen and the antero-inferior and postero-inferior parts of the acetabulum. The Kocher approach may injure the artery of the ischium. Letournel's extended lateral approach and Mears' triradiate approach may injure the artery of the ischium and the artery of the roof of the acetabulum. The risk of osteonecrosis appears to be theoretically increased if one adds an endopelvic approach. The anterior approach to the acetabulum appears to be that which theoretically leads to the least devascularization. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server located at http://dx.doi.org/10.1007/s00276-002-0029-2.
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Affiliation(s)
- A Yiming
- Laboratoire d'Anatomie, Faculté de Médecine, Avenue de Vallombrose, 06000 Nice, France
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Baqué P, Pierrefite-Carle V, Gavelli A, Brossette N, Benchimol D, Bourgeon A, Staccini P, Saint-Paul MC, Rossi B. Naked DNA injection for liver metastases treatment in rats. Hepatology 2002; 35:1144-52. [PMID: 11981764 DOI: 10.1053/jhep.2002.32709] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
The cytosine deaminase (CD) gene converts the nontoxic prodrug, 5-fluorocytosine (5-FC), into 5-fluorouracil (5-FU). We previously showed that injection of CD-bearing cancer cells followed by 5-FC treatment can act as an autologous tumor vaccine in a syngenic liver metastasis model in rats. In the present work, we analyzed the antitumor efficiency of a direct intratumoral injection of a CD-expressing plasmid. In rats bearing microscopic or macroscopic metastases in right and left liver lobes, an injection of a CD-expressing plasmid was performed in the left lobe tumor, followed by 5-FC treatment of the animals. A significant regression of the DNA-injected tumor was observed in 5-FC-treated rats, both in microscopic (P =.007) or advanced (P <.0001) tumor models. Moreover, this treatment also induced a potent distant bystander effect on untreated controlateral liver tumors and extrahepatic metastases, resulting in an increased survival compared with control animals in both tumor models (P <.05). In conclusion, these data suggest that direct intratumoral injection of a CD-expressing plasmid, associated to 5-FC administration, can constitute a powerful and innocuous alternative treatment for unresectable liver metastases from colon carcinoma.
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Affiliation(s)
- Patrick Baqué
- Service de Chirurgie Abdominale et Thoracique, Hôpital l'Archet II, Nice cédex 3, France
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Chevallier P, Baqué P, Benchimol D, Bernard J, Souci J, Chevallier A, Bourgeon A, Padovani B. [Treatement of colorectal obstruction with self-expanding metallic stents under fluoroscopic guidance]. J Radiol 2002; 83:473-7. [PMID: 12045744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
PURPOSE To prospectively evaluate fluoroscopic-assisted insertion of self-expanding metallic stents before surgery or for palliative treatment of soft tissue colorectal obstruction. Materials and methods. From January 1999 to October 2000, 18 consecutive patients with colorectal obstruction were included in the study. Treatment with self-expanding metallic stent was either the first line of treatment before surgery (n=8) (group I) or purely palliative (n=10) (group II). Colic stenosis was located proximal to the sigmoid in seven cases. RESULTS Technical success was achieved in 83.3% of cases and colic decompression was observed after 48 hours in all patients with a stent. Thirty days mortality and stent related complications were respectively 0% and 37.5% for group I, and 20% and 50% for group II. All complications were minor except for one colic perforation by a guidewire. CONCLUSION Stent insertion was effective and provided relief of colic obstruction in the majority of cases. Randomized studies would be necessary to demonstrate a definitive reduction in mortality and morbidity with this technique as compared to the classical surgical approach.
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Affiliation(s)
- P Chevallier
- Service d'Imagerie Médicale, Hôpital Archet II, 151 route e Saint Antoine de Ginestière, BP 3079, 06202 Nice Cedex 3, France.
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Pierrefite-Carle V, Baqué P, Gavelli A, Brossette N, Benchimol D, Bourgeon A, Saint Paul MC, Staccini P, Rossi B. Subcutaneous or intrahepatic injection of suicide gene modified tumour cells induces a systemic antitumour response in a metastatic model of colon carcinoma in rats. Gut 2002; 50:387-91. [PMID: 11839720 PMCID: PMC1773127 DOI: 10.1136/gut.50.3.387] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Suicide gene therapy consists of the transfer into tumour cells of a "suicide" gene that can convert a non-toxic compound into a lethal drug. Expression of the cytosine deaminase gene leads to the conversion of the non-toxic compound 5-fluorocytosine to 5-fluorouracil. We have recently shown that "suicide cell based vaccination" consisting of intrahepatic injection of cytosine deaminase expressing colon cancer cells followed by 5-fluorocytosine treatment induces regression of a distant wild-type liver tumour in rats. AIMS This study was conducted to test if (i) a distant bystander effect on a liver tumour can be induced after subcutaneous suicide cell based vaccination and (ii) suicide cell based vaccination is efficient in limiting tumour dissemination to extrahepatic compartments. METHODS An aggressive variant of rat colon carcinoma cells was selected after successive passages in vitro. Rats carrying an experimental liver "metastasis" generated by injection of these cells were vaccinated by subcapsular or subcutaneous injection of cytosine deaminase expressing cells followed by 5-fluorocytosine treatment. RESULTS Subcutaneous and subcapsular vaccination induced 70% regression in the median volume of the pre-established liver tumour (p=0.001) and abolished tumour dissemination compared with control animals. CONCLUSIONS This study has compared for the first time the efficiency of subcutaneous and intrahepatic suicide cell based vaccination in a metastatic colorectal carcinoma model in rats. The results indicate that both modes of vaccination are equally efficient in inducing a systemic antitumour response, suggesting that this strategy is a powerful approach against the development and dissemination of metastatic colon carcinoma.
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Affiliation(s)
- V Pierrefite-Carle
- Unité INSERM 364, IFR 50, Faculté de Médecine, Avenue de Valombrose, 06107 Nice cedex 2, France.
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Hardwigsen J, Baqué P, Crespy B, Moutardier V, Delpero JR, Le Treut YP. Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: a 14-patient series. Ann Surg 2001; 233:242-9. [PMID: 11176131 PMCID: PMC1421207 DOI: 10.1097/00000658-200102000-00014] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the outcome of resection of the suprarenal or infrarenal inferior vena cava (IVC) and possible indications for prosthetic replacement. SUMMARY BACKGROUND DATA Involvement of the IVC has long been considered a limiting factor for curative surgery for advanced tumors because the surgical risks are high and the long-term prognosis is poor. Prosthetic replacement of the IVC is controversial. METHODS The authors retrospectively reviewed a 7-year series of 14 patients who underwent en bloc resection including a circumferential segment of the IVC. The tumor was malignant in 12 patients and benign in 2. The resected segment of the IVC was located above the kidneys in eight patients and below in six. Resection was performed without extracorporeal circulation in all patients. RESULTS In all but one patient, IVC resection was associated with multivisceral resection, including extended nephrectomy (n = 8), major hepatic resection (n = 3), digestive resection (n = 3), and infrarenal aortic replacement (n = 2). Prosthetic replacement of the IVC was performed in eight patients cases and was more common after resection of a suprarenal (6/8) than an infrarenal segment of the IVC (2/6). One patient died of multiorgan failure. Major complications occurred in 29% of patients. Symptomatic complications of prosthetic replacement occurred in one patient (acute postoperative thrombosis, successfully treated by surgical disobstruction). Graft-related infection was not observed. Marked symptoms of venous obstruction developed in three of the six patients who did not undergo venous replacement. In patients undergoing surgery for malignant disease, the estimated median survival was 37 months and the actuarial survival rate was 67% at 1 year. CONCLUSION Multivisceral resection including a segment of IVC is justified to achieve complete extirpation in selected patients with extensive abdominal tumors. Prosthetic replacement of the IVC may be required, particularly in cases of suprarenal resection. It is a safe procedure with a low complication rate and good functional results.
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Affiliation(s)
- J Hardwigsen
- Department of Surgery and Liver Transplantation, Hôpital de la Conception, Marseille, France
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Abstract
The authors report three cases of endometriosis of the rectus abdominis muscle, presenting as a mass of the abdominal wall associated with pain during menstruation in women with a history of cesarean section. Treatment consisted in wide surgical resection followed by prosthetic abdominal wall repair in one recurrent case. Abdominal wall endometriosis is a rare disease that can be explained by grafting of endometrial cells to the abdominal wall during laparotomy for pelvic surgery, particularly cesarean section. Isolation of the abdominal wall during cesarean section and irrigation of the abdominal wall at the end of the operation are two theoretical measures designed to prevent endometrial cell engraftment. When abdominal wall endometriosis occurs, only radical surgical resection can prevent recurrence.
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Affiliation(s)
- O Toullalan
- Service de gynécologie obstétrique, hôpital l'Archet II, 151, route de Saint-Antoine-de-Ginestière, BP 3079, 06202 Nice, France
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Gavelli A, Baqué P, Mala M, Saint-Paul MC, Staccini P, Brossette N, Chazal M, Milano G, Gugenheim J, Benchimol D, Bourgeon A, Huguet C, Rossi B, Pierrefite-Carle V. [Vaccination by suicide gene therapy against a model of hepatic metastasis from colon cancer in the rat]. Ann Chir 2000; 125:552-9. [PMID: 10986767 DOI: 10.1016/s0003-3944(00)00240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
UNLABELLED Suicide gene therapy consists of transferring into tumor cells a viral or bacterial gene encoding for an enzyme which converts a non-toxic product into a lethal drug. STUDY AIM To analyze the therapeutic potential of vaccination with tumor cells expressing the bacterial cytosine deaminase (CD) gene and 5-fluorocytosine (5-FC) treatment in a rat liver metastasis model. MATERIAL AND METHOD We used a rat colon carcinoma cell line which, after subcapsular or intraportal injection in syngenic animals, generates single or multiple experimental liver metastases, respectively. We have shown that introduction of a vector expressing the CD gene in this colon carcinoma cell line results in 5-FC sensitivity (PRObCD). RESULTS Intrahepatic subcapsular injection of PRObCD tumor cells, followed by 5-FC treatment, induces total regression of a wild-type tumor pre-established in the contralateral liver lobe in 45% of animals with a 96% decrease in mean volume (p < 0.0001), demonstrating the existence of a distant bystander effect. This vaccination significantly increased the survival of rats with single (log-rank p < 0.0001) or multiple (log-rank p = 0.01) liver metastasis CONCLUSIONS These results suggest that suicide gene-modified tumor cells can act as potent therapeutic vaccines against liver metastasis from colon carcinoma.
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Affiliation(s)
- A Gavelli
- Unité Inserm 364, faculté de médecine, Nice, France
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Pierrefite-Carle V, Gavelli A, Brossette N, Baqué P, Benchimol D, Bourgeon A, Staccini P, Rossi B. Re: Cytosine deaminase/5-fluorocytosine-based vaccination against liver tumors: evidence of distant bystander effect. J Natl Cancer Inst 2000; 92:494-5. [PMID: 10716970 DOI: 10.1093/jnci/92.6.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pierrefite-Carle V, Baqué P, Gavelli A, Mala M, Chazal M, Gugenheim J, Bourgeon A, Milano G, Staccini P, Rossi B. Cytosine deaminase/5-fluorocytosine-based vaccination against liver tumors: evidence of distant bystander effect. J Natl Cancer Inst 1999; 91:2014-9. [PMID: 10580026 DOI: 10.1093/jnci/91.23.2014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The cytosine deaminase gene of Escherichia coli converts the nontoxic compound 5-fluorocytosine into 5-fluorouracil (5-FU), thereby acting as a suicide gene when introduced into cancer cells, killing the cells when they are exposed to 5-fluorocytosine. We analyzed the efficacy of using cytosine deaminase-bearing cancer cells as an autologous tumor vaccine in a rat model that mimics liver metastasis from colon carcinoma. METHODS We introduced a plasmid vector containing the E. coli cytosine deaminase gene into a BDIX rat colon carcinoma cell line. Intrahepatic injection of the modified cells in syngeneic animals generates a single experimental liver "suicide tumor." We then analyzed the effect of 5-fluorocytosine treatment in terms of regression of cytosine deaminase-expressing cells in vivo as well as protection against wild-type cancer cells. RESULTS Treatment with 5-fluorocytosine induced regression of cytosine deaminase-expressing (CD+) tumors, with seven of 11 treated animals being tumor free at the end of 30 days and a statistically significant difference in tumor volumes between treated and control animals (two-sided P<.0001). Intrahepatic injection of CD+ cells followed by 5-fluorocytosine treatment rendered the treated animals resistant to challenge with wild-type tumor cells, with no (zero of seven) treated animals developing wild-type tumors in contrast to all (four of four) control animals. Moreover, in animals with established wild-type liver tumors, injection of CD+ tumor cells followed by 5-fluorocytosine treatment produced a statistically significant increase in survival time (two-sided P<.0001). In vivo immunodepletion and immunohistologic analysis of experimental tumors indicate that natural killer cells are the major immune component involved in this antitumor effect. CONCLUSIONS AND IMPLICATIONS Taken together, these results suggest the potential use of suicide gene-modified tumor cells as therapeutic vaccines against liver metastasis from colon carcinoma.
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Affiliation(s)
- V Pierrefite-Carle
- V. Pierrefite-Carle, B. Rossi, Unité INSERM 364, Faculté de Médecine, Nice, France.
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Benchimol D, Baqué P. [Stomach cancer. Diagnosis, evolution, principles of treatment]. Rev Prat 1999; 49:1329-36. [PMID: 10488666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- D Benchimol
- Service de chirurgie abdominale et thoracique, Hôpital l'Archet II, Nice
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Benchimol D, Baqué P. [The natural history and complications of esophageal cancer]. Rev Prat 1999; 49:1172-6. [PMID: 10416347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Squamous cell carcinoma of the oesophagus has a poor prognosis, owing in part to the compromised status of the patients. Early oesophageal cancer is rarely diagnosed, even if its endoscopic aspects are well known. From the mucosa, the disease progresses step by step, and also via the submucosa. Furthermore, multiple locations are not uncommon. Bulky tumours progressively obstruct the oesophageal lumen while infiltrative tumours invade the oesophageal layers, and then the perioesophageal fat and the mediastinal organs. Involvement of mediastinal, cervical and abdominal lymph nodes occurs early. Distant metastases occur later. Complications are mainly due to the locoregional spread of the disease, leading to death.
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Affiliation(s)
- D Benchimol
- Service de chirurgie abdominale et thoracique, Hôpital l'Archet II, Nice
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Benchimol D, Myx A, Mouroux J, Baqué P, Bernard JL, Bourgeon A, Richelme H. [Adenocarcinoma in Barrett's esophagus. A study of 28 resected cases]. Chirurgie 1999; 124:141-8. [PMID: 10349750 DOI: 10.1016/s0001-4001(99)80056-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
STUDY AIM The aim of this retrospective study was to report a series of 28 patients with adenocarcinoma (ADK) arising in Barrett's esophagus (BE), treated by esophagectomy. PATIENTS AND METHODS From 1992 to 1998, 28 patients were operated on for ADK in BE. There were 27 men and one woman (mean age: 65 years) classified as ASA I (n = 2), ASA II (n = 15) and ASA III (n = 11). Eighteen patients had a long story of gastro-esophageal reflux disease which required surgical repair in five of them. Dysphagia was the main symptom (n = 19). Surgical procedures included 15 Ivor Lewis operations, nine esophagectomies without thoracotomy and four esophagogastrectomies by the left thoracic approach. RESULTS Pathological examination of the specimens showed an EBO with adenocarcinoma (n = 27) and a high grade dysplasia (n = 1). Among five patients with a previously known BE, three under endoscopic surveillance had high grade dysplasia (n = 1) and limited T1 tumor (n = 2), while the other two patients without surveillance developed an invasive tumor (T3N1). There were three postoperative deaths (mortality rate: 10%), all arising from pulmonary failure. Median survival was 16.6 months. All patients resumed a normal diet. The actuarial survival rates were 63%, 42% and 15.2% respectively at 1, 2 and 4 years. A multivariate analysis could identify 3 prognostic factors: ASA score previously known BE under surveillance, length of BE. CONCLUSION Adenocarcinoma arising in BE is very often diagnosed too late. Patients with high risk BE require an endoscopic survey. High grade dysplasia detected in two successive examinations by two different pathologists may require prophylactic esophagectomy, but local endoscopic management presently under evaluation could be efficient in the future.
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Affiliation(s)
- D Benchimol
- Service de chirurgie abdominale et thoracique, hôpital de l'Archet II, Nice, France
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Chazal M, Benchimol D, Baqué P, Pierrefite V, Milano G, Bourgeon A. Treatment of hepatic metastases of colorectal cancer by electrochemotherapy: an experimental study in the rat. Surgery 1998. [PMID: 9736907 DOI: 10.1016/s0039-6060(98)70100-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Electrochemotherapy, which consist of local or systemic administration of a cytotoxic agent followed by application of electric pulses to a tumor, has proved effective for various types of tumors in animals and for cutaneous and head and neck cancers in human beings. This is the first study to investigate the efficacy of electrochemotherapy for treatment of hepatic metastases of colorectal cancer in the rat. METHODS After induction of a solitary hepatic metastasis in 36 male BDIX rats, the animals were randomized to one of four groups: B-E-(no treatment), B+E-(intratumoral bleomycin), B-E+ (application of electric pulses to the tumor), and B+E+ (electrochemotherapy: intratumoral bleomycin followed by application of electric pulses). RESULTS Groups B-E and B-E+ had no tumor response. Group B+E had one partial response. Group B+E+ had seven partial responses and two complete responses. The difference in terms of response between group B+E+ and the other three groups was statistically significant (P < .05). Comparison of the mean posttherapy tumor volumes (B-E-, 50.6 mm3; B+E-, 58.7 mm3; B-E+, 46 mm3; and B+E+, 5.65 mm3) revealed a significantly smaller residual tumor in group B+E+ than in the other three groups (P < .05). CONCLUSIONS Electrochemotherapy is an effective means to reduce the volume of hepatic metastases of colorectal cancer in the rat. Additional research is required to determine the optimum treatment duration, dose effects, volume of tumor that can be treated by electrochemotherapy, and impact on survival. Such experimental studies are indispensable prerequisites for clinical trials.
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Affiliation(s)
- M Chazal
- Service de Chirurgie Abdominale et Thoracique, Hpital de 1 Archet 11, Nice France
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Chazal M, Benchimol D, Baqué P, Pierrefite V, Milano G, Bourgeon A. Treatment of hepatic metastases of colorectal cancer by electrochemotherapy: an experimental study in the rat. Surgery 1998; 124:536-40. [PMID: 9736907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Electrochemotherapy, which consist of local or systemic administration of a cytotoxic agent followed by application of electric pulses to a tumor, has proved effective for various types of tumors in animals and for cutaneous and head and neck cancers in human beings. This is the first study to investigate the efficacy of electrochemotherapy for treatment of hepatic metastases of colorectal cancer in the rat. METHODS After induction of a solitary hepatic metastasis in 36 male BDIX rats, the animals were randomized to one of four groups: B-E-(no treatment), B+E-(intratumoral bleomycin), B-E+ (application of electric pulses to the tumor), and B+E+ (electrochemotherapy: intratumoral bleomycin followed by application of electric pulses). RESULTS Groups B-E and B-E+ had no tumor response. Group B+E had one partial response. Group B+E+ had seven partial responses and two complete responses. The difference in terms of response between group B+E+ and the other three groups was statistically significant (P < .05). Comparison of the mean posttherapy tumor volumes (B-E-, 50.6 mm3; B+E-, 58.7 mm3; B-E+, 46 mm3; and B+E+, 5.65 mm3) revealed a significantly smaller residual tumor in group B+E+ than in the other three groups (P < .05). CONCLUSIONS Electrochemotherapy is an effective means to reduce the volume of hepatic metastases of colorectal cancer in the rat. Additional research is required to determine the optimum treatment duration, dose effects, volume of tumor that can be treated by electrochemotherapy, and impact on survival. Such experimental studies are indispensable prerequisites for clinical trials.
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Affiliation(s)
- M Chazal
- Service de Chirurgie Abdominale et Thoracique, Hpital de 1 Archet 11, Nice France
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Baqué P, Trojani C, Batt M, Hassen-Khodja R, Bariseel H, Pittaluga P, Declémy S, Prate B, Le Bas P. Lower limb trauma caused by power-driven cultivators: report of 23 cases. J Trauma 1998; 45:485-8. [PMID: 9751537 DOI: 10.1097/00005373-199809000-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the mechanism and the severity of injuries caused by power-driven cultivators. METHODS This retrospective study analyzed the clinical records of 20 patients treated from 1984 to 1996 for a total of 23 lower limb injuries caused by power-driven cultivators (three patients had bilateral injuries) in the Nice University Hospital. RESULTS A total of 90% of the accidents occurred when the machine was put into reverse and the limb was caught by the rotary blades; the cause of the remaining accidents was unknown. Of the 23 patients, 10 patients (43.5%) suffered posterior dislocation of the knee due to forced hyperextension. Injuries were classed in two groups as a function of their prognosis: group I consisted of osteomuscular lesions without vascular or nerve involvement (11 lower limbs, 11 patients). The mortality rate in this group was 9%, the rate of major amputation was 18%, and the prognosis was favorable in 82% of the cases. Group II corresponded to lower limb injuries with neurovascular involvement (12 lower limb injuries in 10 patients: one patient belonged to both group I and group II). Acute lower limb ischemia was constant in group II; the mortality rate was 20% (two of 10 patients), and the rate of major amputation was 41.6% (five of 12 patients; three emergency amputations and two secondary amputations). CONCLUSION These agricultural machines can cause severe trauma, and the resulting wounds are contaminated by telluric germs in rural areas. Paradoxically, power-driven cultivators are not legally classified as "dangerous machines." Modification of existing legislation in this field would seem advisable.
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Affiliation(s)
- P Baqué
- Service de Chirurgie Vasculaire, Hôpital Saint-Roch, Nice, France
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