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Nicolas Santucci Olivier Facy Pablo Ortega-Deballon Jean-Baptiste Lequeu Paul Rat Patrick Rat 《Pancreatology》2018,18(6):666-670
Background
Surgical resection remains the only curative option for pancreatic adenocarcinoma. Despite recent improvements in medical imaging, unresectability is still often discovered at the time of surgery. It is essential to identify unresectable patients preoperatively to avoid unnecessary surgery. High serum CA 19-9 levels have been suggested as a marker of unresectability but considered inaccurate in patients with hyperbilirubinemia.Aim of the study
To evaluate CA 19-9 serum levels as a predictor of unresectability of pancreatic adenocarcinomas with a special focus on jaundiced patients.Methods
All patients presenting with histologically-confirmed pancreatic adenocarcinoma and having serum CA 19-9 levels available prior to any treatment were included in this retrospective study. The relationship between serum concentrations of CA 19–9 and resectability was studied by regression analysis and theROC curves obtained. A cut-off value of CA 19–9 was calculated. In jaundiced patients, a CA 19–9 adjusted for bilirubinemia was also evaluated.Results
Of the 171 patients included, 49 (29%) were deemed resectable and 122 (71%) unresectable. Altogether, 93 patients (54%) had jaundice. The area under the ROC curve for CA 19–9 as a predictor of resectability was 0.886 (95%CI:[0.832–0.932]); in jaundiced patients it was 0.880 (95% CI [0.798–0.934]. A cut-off in CA 19–9?at 178 UI/mlyielded 85% sensitivity, 81% specificity and 91% positive predictive value for resectability. There was no correlation between the levels of bilirubin and CA 19–9 (r?=?0.149).Conclusion
Serum CA 19–9 is a good predictive marker of unresectability of pancreatic adenocarcinoma, even in jaundiced patients. CA 19-9 levels over 178 UI/ml strongly suggest unresectable disease. 相似文献3.
Pablo Ortega-Deballon François Radais Olivier Facy 《Clinical journal of gastroenterology》2008,1(4):157-159
Pneumatosis intestinalis and aeroportia are typical findings of mesenteric ischemia. The second carries a worse prognosis
than the former. We report the case of a patient presenting with acute abdominal pain and acidosis after admission to the
coronary unit for myocardial infarction. An emergent abdominal CT scan showed aeroportia. Laparotomy confirmed extended bowel
necrosis. Aeroportia is a typical feature of ischemic bowel necrosis, often associated with advanced disease and bad prognosis.
In the presence of acute abdominal pain, aeroportia should be considered as a sign of ischemic bowel necrosis. Emergent laparotomy
is warranted. 相似文献
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Romain B. Fabacher T. Ortega-Deballon P. Montana L. Cossa J.-P. Gillion J.-F. 《Hernia》2022,26(1):189-200
Hernia - To assess the rate of late chronic postoperative inguinal pain (CPIP) after groin hernia repair in patients with different categories of preoperative VRS (Verbal Rating Scale) pain and to... 相似文献
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Pablo Ortega-Deballon Laurence Duvillard Marie-Lorraine Scherrer Sophie Deguelte-Lardière Abderrahmanne Bourredjem Jean-Michel Petit Claire Bonithon-Kopp 《International journal of colorectal disease》2014,29(1):23-29
Background
Infections are the leading cause of morbidity and mortality after colorectal surgery. Obesity is a well-known risk factor for wound infection, but it does not seem to increase the risk of other infectious complications. The aim of this study was to look for a relationship between the fatty tissue metabolism measured by adipocytokine levels and the risk of postoperative infection.Patients and methods
Preoperative plasma levels of eight adipocytokines, cholesterol, triglycerides, insulin and C-reactive protein (CRP) were measured in consecutive patients undergoing elective colorectal surgery between June 2008 and June 2011. Information about epidemiological and clinical characteristics was obtained for each patient. All infections in the 30 days following surgery were recorded.Results
Among the 174 patients included, 49 (28 %) presented with a postoperative infection: 41 surgical site infections and 8 other infections. Preoperative leptin, insulin and CRP were significantly higher in patients with postoperative infection (p?=?0.025, p?=?0.020 and p?=?0.044, respectively), but only leptin was predictive of infection in multivariate analysis (odds ratio (OR)?=?1.89, 95 % confidence interval (CI) 1.18–3.03, p?=?0.008). The predictive value of leptin was slightly lower for surgical site infection (OR?=?1.65, 95 % CI 1.06–2.55, p?=?0.025). Leptin levels were independent of the other adipocytokine levels but not of the body mass index.Conclusion
Although markers of inflammation and insulin resistance are also related to the onset of surgical infection, leptin correlates more closely with the risk of infection than does any other factor. However, its effect could be partially mediated by the body mass index. 相似文献6.
Background
Bariatric surgery is developing at a fast pace. It involves a large number of health care professionals. Among those, general practitioners should have an outstanding position: obesity diagnosis, initial medical management, advising and possibly referring the patient to surgical intervention, participating in the post-surgical follow-up. This study aims at assessing the actual role of general practitioners in initiating bariatric surgery.Materials and methods
Questionnaires were sent to general practitioners who had one patient undergoing bariatric surgery in Dijon University Hospital between March 2013 and April 2015. The questionnaire addressed the health care history of patients before surgery, the impressions of the general practitioners regarding their role and their knowledge about that type of surgery, and the relationships between the general practitioners and the hospital multi-disciplinary team.Results
Among the 48 general practitioners who received questionnaires, 39 have answered. 19 of them had given positive advice to a surgical intervention, but only 8 had taken the initiative to recommend it. Once the decision to operate was made, 21 general practitioners offered their patients an ad hoc medical follow-up, whereas 18 relied entirely upon the hospital team for patient treatment. Although 22 general practitioners had some reserves on bariatric surgery in the first place, 23 were in favour of such surgery after their patients were operated on. 33 general practitioners out of 39 were strongly in favour of liaison data sheets, but most general practitioners apparently did not wish to play a more important role in the treatment decision (32 of them declined to be involved in the hospital multi-disciplinary team).Conclusion
The role of general practitioners concerning the bariatric surgery is still evolving. General practitioners are often involved in the medical treatment of obesity but they seem to be less active in the initiation of surgical treatment, although they support and advise their patients. Better training and information on this topic increase the confidence that general practitioners have in this type of surgery, thus improving the peri-operative management of patients and the subsequent medical follow-up, in which general practitioners have a prominent part to play.7.
Benoit L Faivre L Cheynel N Ortega-Deballon P Facy O Marty M Olschwang S Fraisse J Cuisenier J 《Journal of clinical gastroenterology》2007,41(3):297-300
Desmoid tumors may occur sporadically or as part of the extraintestinal manifestations of familial adenomatous polyposis. Different phenotypes have been described and some genotype-phenotype correlations have been raised, associated with different sites of germline mutations in the adenomatous polyposis coli (APC) gene. We report on a 42-year-old woman ascertained for a large desmoid tumor of the anterior chest wall with pleural involvement, which persistently recurred despite a decade of treatment including hormone therapy, chemotherapy, and surgery. Spontaneous disappearance of the tumor was later noted after 1 year without any treatment and confirmed after 4 years of regular follow-up. Repeated colonoscopies were normal in the proband and DNA sequencing showed a frameshift mutation due to a single adenosine deletion at position 5772 (codon 1924). This mutation, located in the exon 15 at the 3' end of the APC gene, leads to an unusual and late onset phenotype. The pedigree revealed other isolated or familial adenomatous polyposis-associated cases of desmoid tumors. This family report shows that a molecular analysis of the APC gene should be performed in familial desmoid tumors for accurate genetic counseling and follow-up. 相似文献
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Iatrogenic biliary injuries during cholecystectomy 总被引:2,自引:0,他引:2
Ortega-Deballon P Cheynel N Benoit L Di Giacomo G Favre JP Rat P 《Journal de chirurgie》2007,144(5):409-413
AIM OF THE STUDY: To analyze our experience with biliary injuries during cholecystectomy in order to determine associated risk factors, morbidity, and results after reconstruction. PATIENTS AND METHODS: Review of the series of patients referred to our department for biliary injury during cholecystectomy over a 9-year period. Items regarding the type of lesion, risk factors, management, morbidity, and late results were recorded. RESULTS: Fifteen patients were referred to our department for bile duct injury during cholecystectomy between 1997 and 2005 (14 by laparoscopy and four by laparotomy; nine women and nine men). The main surgical indication was biliary colic (n=8). Three patients were operated on in an emergency setting (for acute cholecystitis). In nine patients the gallbladder wall was inflammatory. Intraoperative cholangiography was performed in nine patients, but revealed just one injury. Lateral injury to the bile duct was the most frequent type of lesion. In nine patients, the injury was detected intraoperatively and a biliary drainage was left in place; five of them had a synchronic repair and three required later reconstruction. Nine patients had a delayed identification of biliary injury; six of them required a biliodigestive anastomosis. Two patients died, three had several episodes of acute cholangitis after reconstruction and two presented incisional hernia. CONCLUSION: An inflammatory environment is the main risk factor for biliary injury during cholecystectomy. Bile duct injury is more frequent with laparoscopic cholecystectomy but can also occur with an open approach. Intraoperative cholangiography does not prevent biliary injuries nor detect them accurately. Biliary drainage can reduce morbidity for intraoperatively detected injuries and may be a sensitive approach for the surgeon with no hepatobiliary experience. Morbidity is increased in patients with delayed identification of the injury. 相似文献
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Olivier Facy Fran?ois Radais Sylvain Ladoire Delphine Delroeux Hervé Tixier Fran?ois Ghiringhelli Patrick Rat Bruno Chauffert Pablo Ortega-Deballon 《Journal of experimental & clinical cancer research : CR》2011,30(1):4