Chirurgie des prolactinomes

Surgery usually represents a second line treatment in prolactinomas. In microprolactinomas, it may be indicated in cases of resistance or intolerance to dopamine agonist treatment or when the patient prefers a definitive cure over lifelong medical treatment. In highly trained hands, selective adenomectomy allows normalization of prolactin levels in 75–90% with little morbidity and no mortality. Late recurrence may however occur in up to 20%. In macroprolactinomas, a definitive cure is made unlikely by the often invasive extension of the tumor. A transsphenoidal or less frequently a transfrontal surgical approach is necessary in patients resistant or intolerant to medical treatment, and in rare cases like pituitary apoplexy or cerebrospinal fluid rhinorrhea.     

Intraoperative endoscopy: technique, indications, and results

The technique, indications, and results of intraoperative total enteroscopy were evaluated in 10 patients. A good diagnostic and therapeutic result was achieved in two circumstances: chronic recurring blood loss in the elderly and intussusception in young adults with Peutz-Jeghers syndrome. Endoscopic coagulation of vascular abnormalities and polypectomy were accomplished so that bowel resection could be limited.     

Pancreatic sphincterotomy： Technique, indications, and complications

Pancreatic sphincterotomy serves as the cornerstone of endoscopic therapy of the pancreas. Historically, its indications have been less well-defined than those of endoscopic biliary sphincterotomy, yet it plays a definite and useful role in diseases such as chronic pancreatitis and pancreatic-type sphincter of Oddi dysfunction. In the appropriate setting, it may be used as a single therapeutic maneuver, or in conjunction with other endoscopic techniques such as pancreatic stone extraction or stent placement. The current standard of practice utilizes two different methods of performing pancreatic sphincterotomy： a pull-type sphincterotome technique without prior stent placement, and a needleknife sphincterotome technique over an existing stent. The complications associated with pancreatic sphincterotomy are many, although acute pancreatitis appears to be the most common and the most serious of the early complications. As such, it continues to be reserved for those endoscopists who perform a relatively high-volume of therapeutic pancreaticobiliary endoscopic retrograde chola ngio-pancreatography.     

Endoscopic treatment for chronic pancreatitis: indications, technique, results

Endoscopic treatment associated with or without extracorporeal shock wave lithotripsy (ESWL) for chronic pancreatitis has been employed for about 20 years. Although two randomized control trials have revealed the greater effectiveness of surgery as compared to endoscopic treatment for chronic pancreatitis, a considerable number of patients have successfully obtained complete and long-term relief from pain by the less invasive endoscopic treatment. In this review, we discuss the indications, techniques and results of endoscopic treatment and ESWL for painful chronic pancreatitis. We also discuss the characteristic clinical features that are predictive of a good response to endoscopic treatment and ESWL.     

Capsule endoscopy: technique and indications

Since it was introduced in 2000, capsule endoscopy has become the gold standard for endoscopic examination of the small bowel in several clinical situations such as obscure gastrointestinal bleeding, suspicion of Crohn's disease, and surveillance of polyposis syndromes. In this technique a miniaturised endoscope, embedded in a swallowable capsule, is propelled through the gut by peristalsis and reaches the right colon in 5-8h. Images captured by the capsule are recorded on a hard drive in a belt worn by the patient. In addition to the extensive literature currently available on small bowel CE, new capsule devices are currently under evaluation for the examination of the colon with the purpose of screening for colorectal cancer, and of the oesophagus for screening for oesophageal varices and Barrett's oesophagus. These latter indications currently remain under evaluation. This review considers the technical aspects of capsule endoscopy and discusses the indications. Issues of safety and tolerance are also discussed.     

Laparoscopic-assisted limited liver resection: technique, indications and results

Background/Purpose

The purpose of this work was to evaluate the short-term results of laparoscopic-assisted limited liver resection.

Methods

We analyzed the clinical outcome in 17 patients (mean age 70 ± 8 years) who had undergone laparoscopic-assisted limited liver resection from March 2006 to December 2008. Preoperative diagnoses were HCC in 13 patients and metastasis of colon cancer in 4. The operation consisted of laparoscopic mobilization of the target liver lobe, followed by open liver resection through a 7- to 10-cm extraction site.

Results

Mean tumor size was 3.0 ± 1.1 cm (range 1.2–5 cm). The mean operative time was 362 ± 85 min. The mean blood loss was 451 ± 413 ml, and no blood transfusion was required in any patient. There were no intraoperative complications, and conversion to laparotomy was needed in one case. Postoperative complications developed in 4 cases (4 infections, 24%), all of which were improved by conservative management. However, there was no postoperative mortality. None of the patients had any peritoneal carcinomatosis or port-site or resection site recurrence during a mean follow-up of 18 ± 9.6 months. According to the analysis of the tumor location, the criterion for an adequate tumor location in the right lobe for this operation was set with the tumor at a distance of more than 5 cm from the inferior vena cava and the root of the hepatic vein (5 cm rule).

Conclusion

Laparoscopic-assisted limited liver resection is feasible and well tolerated. Accumulation of more data may be needed for evaluation of long-term outcome.     

Arthroscopic synovectomy in haemophilia: indications, technique and results

Summary.  Recurrent spontaneous haemarthrosis are commonly seen in patients affected by haemophilia. The knee and the elbow are most commonly affected and both are amenable to arthroscopic treatment. Arthroscopic synovectomy is indicated after failure of appropriate medical management with recurrent bleeding. Many patients also demonstrate motion loss and functional deterioration. The benefits of arthroscopic synovectomy include the ability to perform adequate synovial debridement, but also concomitant lysis of adhesion and capsular release to regain range of motion. Results of arthroscopic synovectomy demonstrate a significant decrease in episodes of haemarthrosis, and significant improvement in pain, range of motion and function. The primary predictor of outcome is degree of pre-existing degenerative changes within the joint. In more severe cases, the results of arthroscopic synovectomy are unpredictable and serious consideration should be given to primary arthroplasty.     

Dynamique des complexes de signalisation qui contrôlent l'activation des mastocytes

Mast cell activation is negatively regulated by several mechanisms which use the inositol phosphatase SHIP1 as an effector molecule. This intracellular enzyme dephosphorylates membrane phospholipids which play critical roles in intracellular signaling generated by high-affinity IgE receptors. It determines a sensitivity threshold to extracellular stimuli in resting mast cells; it adjusts the magnitude of allergen-induced responses to the extent of engagement of IgE receptors; it shuts off these responses when allergen-IgG antibody immune complexes coengage inhibitory and activating receptors on the mast cell membrane. The involvement of SHIP1 under these conditions depends on the dynamics of intracellular signaling complexes that build-up underneath engaged receptors and, especially, on their association with the actin cytoskeleton in which are generated and amplified the negative signals which antagonize with IgE receptor-dependent positive signals.     

Computed tomography in 2000: technique, expected progress, limitations, indications

Computed tomography (CT) is today a fundamental technique for thoracic imaging, a logical direct extension of the standard chest x-ray. Since the early 90s, volume-acquisition CT has greatly improved the performance of the conventional technique. After replacing lung and bronchial tomography, the technique has greatly contributed to the reduction in the number of diagnostic conventional angiographies. Certain decisional algorithms have been totally changed, particularly for the diagnosis of pulmonary embolism. In addition, technological advances offer new perspectives, particularly in the field of morphofunctional imaging. There are still many indications for CT and new applications can be expected. Possible drawbacks related to radiation dose and injection of contrast agents must be kept in mind.     

Détermination des seuils de réactivité au cours des allergies alimentaires

It is important for an individual allergic to food to be aware of the threshold (the minimal amount) of the allergenic food that can trigger a reaction. This information is equally essential to the food-processing industry for labeling of pre-packaged foodstuffs. Three methods are available to determine the threshold: case reports, statistical methods and oral provocation tests. Published data available at present allow only limited analysis for three foods (cow milk, chicken egg and peanut). In addition, the absence of standardized oral provocation tests limits determination of thresholds.