Isolated Roux loop pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: a prospective randomized study

Objectives

The optimal strategy for the reconstruction of the pancreas following pancreaticoduodenectomy (PD) is still debated. The aim of this study was to compare the outcomes of isolated Roux loop pancreaticojejunostomy (IRPJ) with those of pancreaticogastrostomy (PG) after PD.

Methods

Consecutive patients submitted to PD were randomized to either method of reconstruction. The primary outcome measure was the rate of postoperative pancreatic fistula (POPF). Secondary outcomes included operative time, day to resumption of oral feeding, postoperative morbidity and mortality, and exocrine and endocrine pancreatic functions.

Results

Ninety patients treated by PD were included in the study. The median total operative time was significantly longer in the IRPJ group (320 min versus 300 min; P = 0.047). Postoperative pancreatic fistula developed in nine of 45 patients in the IRPJ group and 10 of 45 patients in the PG group (P = 0.796). Seven IRPJ patients and four PG patients had POPF of type B or C (P = 0.710). Time to resumption of oral feeding was shorter in the IRPJ group (P = 0.03). Steatorrhea at 1 year was reported in nine of 42 IRPJ patients and 18 of 41 PG patients (P = 0.029). Albumin levels at 1 year were 3.6 g/dl in the IRPJ group and 3.3 g/dl in the PG group (P = 0.001).

Conclusions

Isolated Roux loop PJ was not associated with a lower rate of POPF, but was associated with a decrease in the incidence of postoperative steatorrhea. The technique allowed for early oral feeding and the maintenance of oral feeding even if POPF developed.     

Influence of ankle loading on the relationship between temporal pressure and motor coordination during a whole-body paired task

We investigated whether ankle loading modifies the relationship between temporal pressure and motor coordination during a whole-body paired task. Eight young healthy adults standing in an erect posture performed multiple series of simultaneous rapid leg flexions paired with ipsilateral index finger extensions. They repeated the task ten times in three load conditions: unloaded, loaded (where additional 5-kg inertia was attached to the ankles), and post-loaded (immediately following the loaded condition). These conditions were conducted in two blocks of temporal pressure: self-initiated (SI) versus reaction time (RT). When participants were unloaded, the results showed that index finger extension preceded swing heel-off in RT, and conversely in SI. By contrast, when the participants were loaded, swing heel-off preceded index finger extension in both SI and RT, showing that loading modified the relationship between temporal pressure and movement synchronization in RT only. However, loading did not induce any increase in the error of synchronization. Furthermore, in both the unloaded and loaded conditions, the duration of “anticipatory postural adjustments” (APA) was shorter when the temporal pressure was increased. Interestingly, the shorter APA duration was compensated by an increase in APA amplitude. Thus, loading did not modify the relationship between temporal pressure and anticipatory postural dynamics. Post-loaded and unloaded conditions produced the same results. These results show that the central nervous system optimally adapts the relationship between temporal pressure and motor coordination to transitory changes in the mechanical properties of the lower limbs, here due to ankle loading.     

Ultrasound Effect on Neural Differentiation of Gingival Stem/Progenitor Cells

Dental pulp loss due to caries or pulpitis can affect the longevity of teeth. Dental pulp tissue engineering necessitates the use of progenitor cells that has the potential to differentiate into neural, vascular and odontoblasts like cells. Previous reports have shown that human gingival progenitor cells (HGPCs) can be differentiated into different cell types; however neural differentiation of these cells, to the best of our knowledge, has not been reported. Low intensity pulsed ultrasound (LIPUS) has been reported to enhance cell differentiation. The aims of this study were (1) to explore the potential neural differentiation of HGPCs and (2) to investigate the effect of LIPUS on the differentiation of HGPCs when incubated under neuroinductive conditions. The HGPCs were isolated from human interdental papilla proximal to the premolar teeth that were extracted for orthodontic purpose. The HGPCs were induced to differentiate into neural lineage using a neuroinductive culture medium. HGPCs were divided into four groups; control group, neuro-induction (NI) group, ultrasound group (LIPUS), and a combined NI+LIPUS group. HGPCs were harvested for immunostaining and q-PCR after 1 day. Immunostaining for neuron specific antigens and q-PCR suggested that HGPCs can be differentiated into neural lineage and that selected neurodifferentiation markers can be enhanced by LIPUS.     

Cholangite tuberculeuse simulant une maladie de Caroli : difficultés diagnostiques

Abstract

The liver and the bile ducts represent an exceptional location of tuberculosis. The clinical symptomatology is not specific.We describe three aspects macronodular, micronodular and canalicular which are the rarest.

Purpose

Precise the diagnostic difficulties of this entity insisting on the clinical, biological and morphological signs.

Case report

We report the case of 70 year old man without medical history, admitted for a clinicobiological cholangitis syndrome evolving in a context of impaired general condition. Acute cholecystitis was documented by ultrasound with a moderate dilatationof the common hepatic duct. The bili-MRI showed a dilation of the left intrahepatic bile ducts suggestive of Caroli’s disease. A bi-segmentectomy were performed. Histological examination finds a hepatic tuberculosis and infirm the diagnosis of Caroli’s disease.

Conclusion

Tuberculous cholangitis is rare and poses a diagnostic problem. It can simulate a Caroli disease leading to an unnecessary liver resection. Percutaneous liver biopsy can help to rectify the diagnosis for TBC.     

Visual pigments and opsin expression in the juveniles of three species of fish (rainbow trout,zebrafish, and killifish) following prolonged exposure to thyroid hormone or retinoic acid

Thyroid hormone (TH) and retinoic acid (RA) are powerful modulators of photoreceptor differentiation during vertebrate retinal development. In the embryos and young juveniles of salmonid fishes and rodents, TH induces switches in opsin expression within individual cones, a phenomenon that also occurs in adult rodents following prolonged (12 week) hypothyroidism. Whether changes in TH levels also modulate opsin expression in the differentiated retina of fish is unknown. Like TH, RA is essential for retinal development, but its role in inducing opsin switches, if any, has not been studied. Here we investigate the action of TH and RA on single‐cone opsin expression in juvenile rainbow trout, zebrafish, and killifish and on the absorbance of visual pigments in rainbow trout and zebrafish. Prolonged TH exposure increased the wavelength of maximum absorbance (λ_max) of the rod and the medium (M, green) and long (L, red) wavelength visual pigments in all fish species examined. However, unlike the opsin switch that occurred following TH exposure in the single cones of small juvenile rainbow trout (alevin), opsin expression in large juvenile rainbow trout (smolt), zebrafish, or killifish remained unchanged. RA did not induce any opsin switches or change the visual pigment absorbance of photoreceptors. Neither ligand altered cone photoreceptor densities. We conclude that RA has no effect on opsin expression or visual pigment properties in the differentiated retina of these fishes. In contrast, TH affected both single‐cone opsin expression and visual pigment absorbance in the rainbow trout alevin but only visual pigment absorbance in the smolt and in zebrafish. The latter results could be explained by a combination of opsin switches and chromophore shifts from vitamin A1 to vitamin A2. J. Comp. Neurol. 522:98–117, 2014. © 2013 Wiley Periodicals, Inc.