Facteurs prédictifs de la récidive postopératoire après résection iléocæcale pour maladie de Crohn

Introduction

Although the proven efficacy of many biologic agents in inducing and maintaining remission in Crohn’s disease, near 80% of patients require intestinal resection during their lifetime. This surgery is not definitively curative. In fact, postoperative disease recurrence is common and is considered as a one of the major problems encountered when managing Crohn’s disease. Aims: to assess the risk factors for postoperative recurrence after ileocecal resection for Crohn’s disease.

Patients and methods

The study included all Crohn’s disease patients who underwent ileocecal resection between 2000 and 2009. Disease recurrence was defined as endoscopic evidence of disease activity with or without symptoms. To determine the risk factors for postoperative recurrence of Crohn’s disease; we performed univariate analysis of the different variables proposed in the literature for their influence on the postsurgical outcome followed by multivariate analysis by logistic regression.

Results

Fifty two patients were included. Fifteen patients (28.8%) patients developed disease recurrence within a mean follow up of 31.9 months [1–126]. In univariate analysis, familial history of chronic inflammatory intestinal disease (P = 0.007), ileocecal resection occurring during the first year after the diagnostic of Crohn’s disease (P = 0.004), length of the resected small bowel (P = 0.025) and presence of granulomas(P = 0.035)were associated with a high risk of postoperative recurrence. In multivariate analysis, surgery during the first year after the diagnostic of Crohn’s disease was the only independent variable correlated to postoperative recurrence.

Conclusion

After an ileocecal resection for Crohn’s disease, the recurrence is relatively common particularly in patients who underwent their surgery during the first year after the diagnostic of CD.     

Potentialités et intérêt du tissu adipeux dans la sclérodermie

Systemic sclerosis is a disorder involving the connective tissue, arterioles and microvessels. It is characterized by skin and visceral fibrosis and ischemic phenomena. Currently, therapy is limited and no antifibrotic treatment has proven its efficacy. Beyond some severe organ lesions (pulmonary arterial hypertension, pulmonary fibrosis, scleroderma renal crisis), which only concern a minority of patients, the skin sclerosis of hands and face and the vasculopathy lead to physical and psychological disability in most patients. Thus, functional improvement of hand motion and face represents a priority for patient therapy. Due to its easy obtention by fat lipopaspirate and adipocytes survival, re injection of adipose tissue is a common therapy used in plastic surgery for its voluming effect. Identification and characterization of the adipose tissue-derived stroma vascular fraction, mainly including mesenchymal stem cells, have revolutionized the science showing that adipose tissue is a valuable source of multipotent stem cells, able to migrate to site of injury and to differentiate according to the receiver tissue's needs. Due to easy harvest by liposuction, its abundance in mesenchymal cells far higher that the bone marrow, and stroma vascular fraction's ability to differentiate and secrete growth angiogenic and antiapoptotic factors, the use of adipose tissue is becoming more attractive in regenerative medicine. We here present the interest of adipose tissue use in the treatment of the hands and face in scleroderma.     

Le lymphangiome kystique rétropéritonéal récidivant chez l’adulte

Cystic lymphangioma is a rare benign vascular tumor that may arise in various sites, revealed at any age. Abdominal locations represent less than 10% of the cases preferentially involving the mesentery. The retroperitoneal site is less frequent. The authors report the case of a 30-year-old woman who was admitted for an abdominal mass that appeared over the last one year. In her past, she was operated for a cystic mass and the anatomopathologist concluded it to be a cystic lymphangioma. Abdominal scan showed a retroperitoneal cystic mass. Surgical exploration revealed a retroperitoneal cystic tumor. Anatomopathologic examination concluded it to be a cystic lymphangioma. The cystic lymphangioma is a benign malformative tumor of the lymphatic system, its diagnosis requires a histological confirmation. Surgery is the best curative treatment with complete excision, the prognosis is excellent.     

Lymphangiome kystique rétropéritonéal

The cystic lymphangioma is a vascular tumor that arises at the expense of lymphatic vessels. It is a rare and benign dysplasia that occurs mainly in children. Adult forms are rare. Its expression is mainly cervical or axillary, with a few locations in the abdominal cavity. We report the case of a patient who presented with cystic lymphangiomas located in the retroperitoneal region. Various clinical aspects, diagnosis and treatment were studied.     

Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period.MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25 ± 13 years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest.ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n = 2). Morbidity was marked by conduction abnormalities (n = 2), bleeding and hematoma of the residual cavity that required surgical treatment (n = 3). Eleven patients were followed with a mean period of 40.5 ± 19.4 months. At follow-up, neither late deaths nor recurrence have occurred.ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.