Potential Impact of in Situ Liver Splitting on the Number of Available Grafts

Transplantation. Jul, 2002  |  Pubmed ID: 12151735

The potential increase in the number of liver grafts gained from systematically using the technique of splitting optimal organs is still unknown. This study investigates the proportion of donors that should be considered for in situ split-liver harvesting according to strict criteria on which a consensus could be reached easily.

Highly Efficient Lentiviral Vector-mediated Transduction of Nondividing, Fully Reimplantable Primary Hepatocytes

Molecular Therapy : the Journal of the American Society of Gene Therapy. Aug, 2002  |  Pubmed ID: 12161186

Gene therapy is an attractive approach for the treatment of liver disease. We demonstrate that a so-called third-generation human immunodeficiency virus (HIV)-derived vector system can govern the efficient delivery, integration, and stable expression of a transgene into primary human hepatocytes in the complete absence of cell division. We also show that rodent hepatocytes exhibit a significant degree of resistance to HIV vector-mediated transduction, a phenotype that is particularly pronounced in murine hepatocytes and that results from a block in the immediate-early phase of infection. We finally describe a methodology, that allows very high rates of transduction through minimal in vitro manipulation, in which hepatocytes are kept in suspension and reimplanted within a few hours of harvest with a fully preserved engraftment potential. These results have immediate implications for the treatment of liver diseases by the transplantation of genetically modified hepatocytes, an approach that could be applied to a number of hereditary and acquired hepatic disorders.

Liver Transplantation for Alcoholic Liver Disease: a Medical and Ethical Debate

Swiss Medical Weekly. Jun, 2002  |  Pubmed ID: 12362289

Arantius' Ligament Approach to the Left Hepatic Vein and to the Common Trunk

Journal of the American College of Surgeons. Nov, 2002  |  Pubmed ID: 12437267

Reduction of Blood Glucose Variability in Type 1 Diabetic Patients Treated by Pancreatic Islet Transplantation: Interest of Continuous Glucose Monitoring

Diabetes Care. Dec, 2002  |  Pubmed ID: 12453970

To compare the glycemic profiles of patients with type 1 diabetes treated with either an implantable insulin pump or pancreas or islet transplantation by the means of the continuous glucose monitoring system (CGMS; Minimed, Sylmar, CA).

Hepatocellular Adenoma and Polycystic Ovary Syndrome

Liver International : Official Journal of the International Association for the Study of the Liver. Feb, 2003  |  Pubmed ID: 12640725

Various identified risk factors predispose to hepatocellular adenomas. We present the case of a young woman with liver adenoma in a context of polycystic ovary syndrome, associated with high levels of androgens and following a high dose hormonal therapy. In view of this complication, we recommend a close screening of patients with such hormonal imbalance, especially those who are treated with high doses of hormones, with repeated liver tests and ultrasonographies.

Kidney-pancreas Transplantation in a Long-term Non-progressor HIV-infected Recipient

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. May, 2003  |  Pubmed ID: 12752321

With the introduction of highly active antiretroviral therapy (HAART), HIV infection has become a chronic disease with more frequent end-stage organ failures. As a result, the question of transplantation in HIV patients is raised more often. Although still subject to controversies, HIV infection is no longer an absolute contraindication to solid organ transplantation. We report a case of combined kidney-pancreas transplantation in a HIV recipient. HIV has remained stable without any antiviral therapy for up to 2 years after transplantation and has reached criteria for inclusion in the long-term nonprogressor (LTNP) group. Grafted organs demonstrated good function without rejection. This case emphasizes the need to consider LTNP HIV patients as a specific subgroup, when discussing solid organ transplantation. HAART is not required, thus sparing drug interactions and their unique immunological features, such as CCR5 mutation, might prevent rejection. This subgroup of HIV patients should be offered less restricted access to transplantation.

Intra-portal Injection of 400- Microm Microcapsules in a Large-animal Model

Transplant International : Official Journal of the European Society for Organ Transplantation. Jun, 2003  |  Pubmed ID: 12819871

To date, encapsulated grafts have usually been implanted in the peritoneal cavity. This site is, however, not ideal, mainly because of its low blood supply. We have investigated the feasibility of intra-portal injection of (400 microm) microcapsules in the pig. Ten-thousand microcapsules per kilogram body weight were injected into six Large White pigs. Portal pressure, various biological tests, portographies and liver histology were recorded before and at various time points after injection. As a result, portal pressure increased after injection (15+/-2.3 vs 8.7+/-1.7 mmHg) but remained within an acceptable range (<20 mmHg) and returned to normal values at 3 months (8.5+/-3.7 mmHg). During the 3-month follow up, liver function and liver tests remained stable. Portographies showed a homogenous implantation of the capsule, with the portal flow always directed to the liver. At histological examination after 3 months the capsules demonstrated various degrees of fibrosis. We can thus conclude that these results demonstrate that intra-portal injection of microcapsules is feasible in a large-animal model. Hemodynamic, biological and radiological results are similar to those observed in clinical free-islet transplantation.

Long Term Results After Complete or Incomplete Surgical Resection of Liver Hydatid Disease

Swiss Medical Weekly. May, 2003  |  Pubmed ID: 12833196

The liver is the organ most frequently infected by hydatid disease and medical therapy alone is ineffective in eliminating the parasite. Surgical options vary from complete resection (e.g. total pericystectomy or hepatectomy) to limited procedures (e.g. percutaneous aspiration or unroofing of cysts). The aim of this study was to determine the long-term outcome after complete or partial resection of liver hydatid cysts.

Current Status of Islet Cell Transplantation

Advances in Surgery. 2003  |  Pubmed ID: 12953637

Islet Autotransplantation After Left Pancreatectomy for Non-enucleable Insulinoma

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. Oct, 2003  |  Pubmed ID: 14510705

Insulinoma is a rare, almost always benign endocrine tumor of the pancreas, clinically characterized by hyperinsulinemic, hypoglycemic episodes. Surgical excision is the therapy of choice, which may lead to postpancreatectomy diabetes mellitus in the case of extensive pancreatic resection. We present the cases and the metabolic follow up of two patients, 81 and 73 years old, with insulinoma localized close to the main duct in the pancreatic neck. Both patients underwent an 80% left pancreatectomy, avoiding a pancreatico-enteric anastomosis. In order to prevent postpancreatectomy diabetes, the islets from the tumor-free part of the resected pancreas were isolated and injected via a right colic vein into the portal system. After a follow up of 6 and 3 years respectively, both patients remained insulin-independent without any dietary restrictions. Fasting and glucagon-stimulated C-peptide-levels and glycosylated hemoglobin remained within normal range. There were no signs of recurrent insulinoma. Liver biopsy performed in one patient at 1 year after autotransplantation, showed intact, insulin-producing islets within the portal spaces. In conclusion, autologous islet transplantation can preserve the insulin secretory reserve after extended left pancreatectomy for the treatment of benign tumors in the pancreatic neck.

Insulin Independence After Conversion to Tacrolimus and Sirolimus-based Immunosuppression in Islet-kidney Recipients

Transplantation. Oct, 2003  |  Pubmed ID: 14557767

Perioperative Management of Patients with Increased Risk of Laparoscopy-induced Hepatic Hypoperfusion

Swiss Medical Weekly. Jan, 2004  |  Pubmed ID: 14745656

Because hepatic hypoperfusion induced by laparoscopy has been underestimated, the aim of this article is to review the numerous factors influencing hepatosplanchnic blood flow during laparoscopy and to alert clinicians to the adverse consequences of hepatic hypoperfusion in high risk patients undergoing this procedure.

Cost Analysis of Human Islet Transplantation for the Treatment of Type 1 Diabetes in the Swiss-French Consortium GRAGIL

Diabetes Care. Apr, 2004  |  Pubmed ID: 15047645

To evaluate the cost of islet transplantation in type 1 diabetic patients with a functional renal graft in a multicenter network.

Ribavirin/interferon-alpha Sequential Treatment of Recurrent Hepatitis C After Liver Transplantation

Transplant International : Official Journal of the European Society for Organ Transplantation. May, 2004  |  Pubmed ID: 15060764

Hepatitis C virus (HCV) infection invariably recurs after liver transplantation (LT), and sequels of chronic hepatitis of the graft are a significant cause of morbidity and mortality. In an uncontrolled trial, 31 patients with histologically confirmed hepatitis C after LT received, sequentially, ribavirin (10 mg/kg body weight q.d.) for 12 weeks, followed by ribavirin at the same dose q.d. plus interferon-alpha (IFN-alpha) [3 million units three times a week (3 MU TIW)] for another 48 weeks. Based on an intent-to-treat analysis, the percentages of patients with undetectable HCV RNA in their serum were 0%, 38.7% and 45.2% after 12, 36 and 60 weeks of therapy, respectively. A sustained virological response, as defined by undetectable serum HCV RNA 24 weeks after the end of treatment, was observed in 9/31 patients (29%). Sustained responders had a significant improvement of their liver inflammatory activity score (P=0.025), but not of their liver fibrosis score. The chances of sustained virological response correlated with the length of treatment, but not with the HCV genotype or baseline HCV RNA level. In conclusion, patients with recurrent hepatitis C after LT might benefit from ribavirin/IFN-alpha therapy, provided that the treatment is tolerated for a sufficient duration of time.

Are Criteria for Islet and Pancreas Donors Sufficiently Different to Minimize Competition?

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. May, 2004  |  Pubmed ID: 15084172

Islet and pancreas transplantation may compete for a limited number of organs. We analyzed records from the national Swiss transplant registry during a 4-year period to investigate the proportion of donors that are suitable for islet and pancreas transplantation. Suitability for pancreas transplantation was mainly defined as: age 10-45 years; weight

Acute Left Colonic Diverticulitis: Can CT Findings Be Used to Predict Recurrence?

AJR. American Journal of Roentgenology. May, 2004  |  Pubmed ID: 15100111

We explored CT and demographic predictors for unfavorable outcome of nonoperative treatment in patients with a first event of left colonic diverticulitis.

Management of Gastrointestinal Stromal Tumors: from Diagnosis to Treatment

Swiss Medical Weekly. Mar, 2004  |  Pubmed ID: 15106018

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the digestive tract. Most gastrointestinal soft tissue neoplasms, previously classified as leiomyomas, schwannomas, leiomyoblastomas or leiomyosarcomas, are today classified as GIST on the basis of molecular and immunohistological features. They originate from gastrointestinal pacemaker cells and are characterised by over-expression of the tyrosine kinase receptor KIT. Overall 5-year survival after surgical resection of GIST is approximately 60%. However, these tumours span a wide clinical spectrum from benign to highly malignant. Prognostic factors have recently been identified for GIST and include tumour size, mitotic rate and other minor factors. At present, surgery is the standard treatment for primary resectable GIST. Benign GIST have an excellent prognosis after primary surgical treatment, with over 90% 5-year survival. While recurrent or malignant GIST, which are resistant to radiotherapy and chemotherapy, had until recently an extremely poor prognosis even after surgical resection, with median survival of 12 months. The development of a tyrosine kinase inhibitor has changed the management of unresectable malignant cases. This new tyrosine kinase inhibitor, imatinib mesylate, which inhibits the c-kit receptor, has proved highly effective against GIST and has improved survival in metastatic GIST. This paper reviews the literature and our experience of GIST, including: diagnosis, pathology, treatment and prognosis.

Does Mechanical Bowel Preparation Have a Role in Preventing Postoperative Complications in Elective Colorectal Surgery?

Swiss Medical Weekly. Feb, 2004  |  Pubmed ID: 15113054

mechanical bowel preparation (MBP) consists of orthograde fluid preparation to clean the bowel. MBP is considered to prevent postoperative complications.

Influence of Islet Transportation on Pancreatic Islet Allotransplantation in Type 1 Diabetic Patients Within the Swiss-French GRAGIL Network

Transplantation. Apr, 2004  |  Pubmed ID: 15114103

The influence of islet transportation on pancreatic islet allotransplantation in type 1 diabetic patients was evaluated within the GRAGIL network.

Are There Any Prognostic Factors for Small Intestinal Stromal Tumors?

American Journal of Surgery. Jun, 2004  |  Pubmed ID: 15191872

Stromal tumors of the digestive tract, or gastrointestinal stromal tumors (GIST), originate from an intestinal mesenchymal precursor cell. Criteria that predict the outcome of small intestinal stromal tumors (SIST) after surgical resection are not clearly established. The aim of the study was to define prognostic criteria for SIST.

[New Results in Allotransplantation of Pancreatic Islet Cells]

Orvosi Hetilap. May, 2004  |  Pubmed ID: 15202327

An up-to-date synthesis of pancreatic islet allotransplantation is included in this summary, with emphasis on new developments and clinical results of the field. Rationale for islet transplantation in type 1 diabetes mellitus, current patient selection criteria, clinical data, technical aspects of organ procurement, islet isolation and transplantation are highlighted. The current challenges are also presented and analysed. Significant advances in clinical islet transplantation have been achieved recently. New immunosuppressive strategies were introduced, there were considerable changes in the patient selection criteria. International collaborations were established in order to standardize islet isolation and transplantation procedures. The spectacular results, recently reported by the Edmonton-group, represent a major breakthrough of the field and the outcomes are comparable with the results of whole pancreas transplantation. Islet transplantation became one of the most promising fields of tolerance induction research. Although still considered experimental, within the frameworks of expanding international collaborations, pancreatic islet allotransplantation gains more and more recognition in the clinical practice. These elements give hope that diabetes might be in the near future treated by islet cell transplantation.

Lymphatic Vessel Density and Vascular Endothelial Growth Factor-C Expression Correlate with Malignant Behavior in Human Pancreatic Endocrine Tumors

Clinical Cancer Research : an Official Journal of the American Association for Cancer Research. Oct, 2004  |  Pubmed ID: 15501970

Metastatic dissemination of tumor cells to regional lymph nodes is a common early feature of many human cancers including pancreatic adenocarcinoma. In contrast, lymph node metastasis is more variably observed in pancreatic endocrine tumors. The objective of this study was to assess the lymphatic system of human pancreatic endocrine tumors and correlate this to clinical behavior. Immunohistochemistry was performed using antibodies to two recently identified markers of lymphatic endothelium, namely, LYVE-1 and podoplanin, and to the lymphangiogenic factor vascular endothelial growth factor (VEGF)-C. As has been reported previously, we observed that in the normal pancreas, islets of Langerhans are devoid of intra-islet lymphatics, but that lymphatics are present in connective tissue in association with ducts and blood vessels. We found that both benign and malignant pancreatic endocrine tumors contain intratumoral lymphatic vessels. Lymphatic vessel density was related to the size of the tumor in benign tumors and to the presence of liver metastasis but not to lymph node metastasis in malignant tumors. VEGF-C was expressed in tumor cells: 4 of 19 (21%) benign tumors were positive, whereas 6 of 9 (67%) borderline tumors and 9 of 11 (82%) carcinomas were positive. These findings strongly suggest that lymphangiogenesis occurs in pancreatic endocrine tumors and that lymphatic invasion and the development of metastases are associated with VEGF-C expression.

Two Colons-two Cancers: Paradigm Shift and Clinical Implications

Journal of Surgical Oncology. Dec, 2004  |  Pubmed ID: 15565587

Embryological and physiological data suggest that proximal (in relation to the splenic flexure) and distal parts of the colon represent distinct anatomical and functional entities. Since 1990, molecular biologists have identified two distinct pathways, microsatellite instability (MSI) and chromosomal instability (CIN), which are involved in the pathogenesis of colon cancer (CC). Thus, a new paradigm has emerged with the discovery that CC is a heterogeneous disease; furthermore recent data have demonstrated that these two distinct pathways in colorectal carcinogenesis are characterized by a different clinical outcome. The implications for the clinicians are twofold; (1) tumors originating from the proximal colon have a better prognosis due to a high percentage of MSI-positive lesions; and (2) location of the neoplasm in reference to the splenic flexure should be documented before group stratification in ongoing trials of adjuvant chemotherapy for CC. In the future, clinical decision-making regarding adjuvant chemotherapy might be stratified according to the MSI status of cancers located proximally to the splenic flexure.

Chemotherapeutic Options in the Management of Anal Cancer

Expert Opinion on Pharmacotherapy. Dec, 2004  |  Pubmed ID: 15571466

During the past two decades, anal cancer has served as a paradigm for the successful application of chemoradiation to solid tumours; so far, it remains one of the few carcinomas of the gastrointestinal tract which are curable without the need for definitive surgery. Since the original contribution by Nigro in 1974, surprisingly few changes have been made to the standard of care in chemotherapy, which still consists of a combination of 5-fluorouracil and mitomycin C. However, many issues have yet to be clarified, such as the potential role of cisplatin as a substitute to mitomycin, as well as treatment-induced toxicity in HIV-positive patients. In this paper, the management of patients with anal cancer is presented, and new chemotherapeutic options are critically reviewed. Finally, the authors' opinion regarding currently unresolved issues in the treatment of these rare neoplasms is expressed.

Mechanical Bowel Preparation for Elective Colorectal Surgery: a Meta-analysis

Archives of Surgery (Chicago, Ill. : 1960). Dec, 2004  |  Pubmed ID: 15611462

There is little scientific evidence to support the routine practice of mechanical bowel preparation (MBP) before elective colorectal surgery in order to minimize the risk of postoperative septic complications.

Reflux, Dysphagia, and Gas Bloat After Laparoscopic Fundoplication in Patients with Incidentally Discovered Hiatal Hernia and in a Control Group

Surgery. Feb, 2005  |  Pubmed ID: 15674207

Laparoscopic fundoplication effectively controls reflux symptoms in patients with gastroesophageal reflux disease (GERD). However, symptom relapse and side effects, including dysphagia and gas bloat, may develop after surgery. The aim of the study was to assess these symptoms in patients who underwent laparoscopic fundoplication, as well as in control subjects and patients with hiatal hernia.

Positron-emission Tomography Imaging of Early Events After Transplantation of Islets of Langerhans

Transplantation. Feb, 2005  |  Pubmed ID: 15699768

The aim of our study was to assess cell trafficking and early events after intraportal islet transplantation. Sprague-Dawley rat islets were incubated for various times, with various concentrations of 2-[F]fluoro-2deoxy-D-glucose (FDG), and in presence of various glucose concentrations. FDG-labeled syngeneic islets or FDG alone were injected in rats. Radioactivity was measured in the liver and in various organs by positron-emission tomography for 6 hours. FDG uptake increased with incubation time or FDG concentration and decreased in presence of glucose. In vivo, all islets implanted in the liver, with an uptake 4.4 times higher than controls (44.2% vs. 10.1%, P=0.02). Radioactivity in the liver decreased at the same rate after injection of labeled-islets and FDG alone. Ex vivo labeling of islets and imaging of posttransplant early events were feasible. Islets engrafted exclusively in the liver. No islet loss could be demonstrated 6 hours after transplantation.

Proximal Location of Colon Cancer is a Risk Factor for Development of Metachronous Colorectal Cancer: a Population-based Study

Diseases of the Colon and Rectum. Feb, 2005  |  Pubmed ID: 15711864

This study was undertaken to assess the incidence of 1) metachronous colorectal cancer and 2) subsequent extracolonic cancers, in relation to the location (proximal or distal to the splenic flexure) of the first primary colorectal tumor.

Assessment of a Novel Two-component Enzyme Preparation for Human Islet Isolation and Transplantation

Transplantation. Jan, 2005  |  Pubmed ID: 15714175

Biologic characteristics of enzyme products used for islet isolation are critical for the success of islet transplantation. In particular, lot-to-lot variability significantly affects the yields of the isolation procedure. In this study, we have evaluated a new enzyme preparation in which highly purified collagenase can be blended with separately supplied neutral protease in a predetermined ratio.

Intussusception As a Cause of Bowel Obstruction in Adults

Swiss Medical Weekly. Feb, 2005  |  Pubmed ID: 15729613

Due to its unspecific presentation, intussusception is often diagnosed with delay in adults.

A Survival Strategy for Anatomy

Lancet. Feb 26-Mar 4, 2005  |  Pubmed ID: 15733715

Surgical Management and Long-term Outcome of Complicated Liver Hydatid Cysts Caused by Echinococcus Granulosus

Surgery. Mar, 2005  |  Pubmed ID: 15746785

The aim of this retrospective study was to evaluate clinical presentation and long-term outcome of patients treated surgically for complicated liver hydatid cysts.

Assessment of Quality of Life in Patients with Rectal Cancer Treated by Preoperative Radiotherapy: a Longitudinal Prospective Study

International Journal of Radiation Oncology, Biology, Physics. Mar, 2005  |  Pubmed ID: 15752893

To assess prospectively the quality of life (QOL) of patients treated by preoperative radiotherapy (RT) and surgery for locally advanced rectal cancer.

Macrophage Depletion Prolongs Discordant but Not Concordant Islet Xenograft Survival

Transplantation. Mar, 2005  |  Pubmed ID: 15753843

T cells and macrophages play a major role in the rejection of xenografted islets. Depending on the phylogenetic disparity, direct or indirect antigen presentation is predominant. The aim of this study was to analyze in vitro the predominance of direct or indirect presentation by depleting antigen-presenting cells in concordant and discordant xenogeneic combinations. In vivo, we analyzed the effect of macrophage depletion on concordant and discordant islet xenograft survival to assess in which combination this strategy can be used as therapeutic tool.

Impact of HLA Matching on the Outcome of Simultaneous Pancreas-kidney Transplantation

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. May, 2005  |  Pubmed ID: 15814550

Simultaneous pancreas-kidney (SPK) transplantation has become the therapy of choice for type 1 diabetic patients with end-stage renal disease. The current analysis examined the impact of human leukocyte antigen (HLA) matching on graft outcome following SPK transplantation. The study population was obtained from patients enrolled in the Euro-SPK 001 study.

Anti-CD154 MAb Treatment but Not Recipient CD154 Deficiency Leads to Long-term Survival of Xenogeneic Islet Grafts

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons. May, 2005  |  Pubmed ID: 15816882

The aim of the study was to evaluate the role of recipient CD40 and CD154 in the rejection process of concordant and discordant islets xenotransplantation (Tx). Diabetic C57BL/6 mice, CD40- or CD154-knockout (KO) and complement C3-deficient (C3-/-) mice were transplanted with either rat or human islets. Group 1, C57BL/6 Tx without therapy; Group 2, C57BL/6 Tx with anti-CD154 monoclonal antibody (mAb) (MR1) therapy; Group 3, CD40-KO; and Group 4, CD154-KO Tx without therapy; Group 5, C3-/- Tx without therapy and Group 6, C3-/-Tx with MR1 therapy. Mixed lymphocyte reactions (MLR) were performed. Compared to Group 1, MR1 induced long-term survival of xenografts in Group 2, but not in Group 6, survival of islets was not prolonged significantly in Groups 3 and 4. MLR responses in Group 2 were reduced approximately 50% compared to Group 1. In Groups 3, 4 and 6, MLR responses were not modified by the absence of CD40 or CD154 molecules, or MR1 and were similar to Group 1. Improved graft survival and reduced MLR responses in Group 2, but not in Group 6, could be explained by specific targeting of activated T cells with inactivation by complement- or cellular-mediated mechanisms. Rejection of xenografts and strong MLR responses in Groups 3 and 4 are possible through efficient activation of alternate pathways of costimulation.

Microbial Surveillance During Human Pancreatic Islet Isolation

Transplant International : Official Journal of the European Society for Organ Transplantation. May, 2005  |  Pubmed ID: 15819808

The aim of the study was to investigate microbiological contamination rate during human pancreatic islet isolation. Between 1996 and 2002, pancreas preservation media and post-purification islet preparations were screened for microbiological contamination. After arrival in the laboratory, pancreata were washed prior to enzyme perfusion with either Hank's balanced salt solution (Group I, n = 170, 1996 to 2001) or decontaminated with polyvidonum-iodine, cefazoline, and amphotericine B (Group II, n = 45, 2001 to 2002). Microbiological contamination of preservation media was observed in 56% and 84% for Groups I and II, respectively. Analysis of contaminants revealed 74% Gram-positive, 21% Gram-negative bacteria and 5% fungi. Duration of transport had an influence on the rate of contamination (P < 0.05). After islet isolation, Group I presented microbial contamination of 16 islet preparations (9.4%) [i.e. Gram-positive bacteria (n = 10), Gram-negative bacteria (n = 4), and fungi (n = 2)]. In Group II, only 2 islet preparations (4.4%) presented microbial contamination. Microbial contamination during pancreas procurement occurs frequently. Most microorganisms are eliminated during islet isolation, and de novo contaminations during islet isolation are rare. Pancreas decontamination reduces the risk of infection of the final islet preparation.

Management of Hepatocellular Carcinoma in the Waiting List Before Liver Transplantation

Journal of Hepatology. 2005  |  Pubmed ID: 15858867

Logistics and Transplant Coordination Activity in the GRAGIL Swiss-French Multicenter Network of Islet Transplantation

Transplantation. May, 2005  |  Pubmed ID: 15880070

Since the Edmonton trial in 2000, increasing numbers of transplant centers have been implementing islet transplantation programs. Some institutions have elected to associate in multicenter networks, such as the Swiss-French GRAGIL (Groupe Rhin-Rhône-Alpes-Genève pour la Transplantation d'Ilots de Langerhans) consortium.

Effect of Microcapsule Composition and Short-term Immunosuppression on Intraportal Biocompatibility

Cell Transplantation. 2005  |  Pubmed ID: 15881425

With higher nutrient and oxygen supply and close contact to blood, the portal vein is a possible alternative to the peritoneal cavity for transplantation of encapsulated cells. Data regarding intraportal biocompatibility of microcapsules are lacking. Microcapsules were built from five alginate types differing in their molar mass and mannuronic/guluronic acid ratios by complex formation with divalent cations (barium or calcium) or mixtures of divalent cations and polycations. They were injected in the portal vein of rats, and cellular and fibrotic pericapsular infiltration thickness was measured 3 and 7 days after implantation. Overgrowth was characterized using various stainings or immunohistochemistry (hematoxylin and eosin, Giemsa, ED-1 for monocyte/macrophage, alpha-actin for myofibroblasts, CD31 for endothelial cells). The impact of short-term immunosuppression (gadolinium-chloride IV 20 mg/kg/day on days--1 and 4 as well as 10 days of rapamycin PO 1 mg/kg/day, tacrolimus PO 3 mg/kg/day, or combinations of rapamycin/tacrolimus or gadolinium/tacrolimus) was further assessed 3, 7, and 42 days after implantation. Overall, overgrowth increased from day 3 to day 7 (p < 0.05). Three and 7 days after implantation, polycation-containing microcapsules induced more reaction than microbeads (p < 0.0001 and p < 0.01). Considering polycation-free beads, barium-alginate induced the weakest reaction. Biocompatibility of microbeads was independent of mannuronic/guluronic acid ratio and molar mass of the alginate. Infiltration was mainly a monocyte/macrophage-rich foreign body reaction, but an eosinophil-containing immunoallergic reaction was also observed. Short-term immunosuppression significantly reduced infiltration in all conditions and up to 42 days after implantation. Biocompatibility after intraportal infusion was best for barium-alginate microbeads and poorest for polycation-containing microcapsules. Short- and long-term overgrowth could be significantly reduced by short-term immunosuppression.

Transplantation of Discordant Xenogeneic Islets Using Repeated Therapy with Anti-CD154

Transplantation. Jun, 2005  |  Pubmed ID: 15940044

Costimulatory blockade has been shown to allow long-term survival of xenogeneic islets. The aim of the present study was to analyze the possibility of xenogeneic islet retransplantation using costimulatory blockade.

A Simple and Highly Effective Method for the Stable Transduction of Uncultured Porcine Hepatocytes Using Lentiviral Vector

Cell Transplantation. 2005  |  Pubmed ID: 16285257

Gene therapy is an attractive approach for the treatment of a wide spectrum of liver diseases. Lentiviral vectors allow the stable integration of transgenes into the genome of nondividing differentiated cells including hepatocytes and could provide long-lasting expression of a therapeutic gene. To develop such approaches, preclinical studies in large animal models such as pigs are necessary to evaluate the feasibility and safety of stable lentiviral integration and long-term vector expression. In addition, effective lentivector-mediated gene transfer onto porcine hepatocytes could advance in cell-based therapies for acute liver failure. To investigate this issue, porcine hepatocytes were transduced in suspension immediately after their isolation in University of Wisconsin (UW) solution containing vitamin E. Up to 80% of hepatocytes stably expressed a GFP transgene after a single exposure to lentiviral vector coding for GFP under the control of either liver-specific or ubiquitous promoters. Moreover, porcine hepatocytes cryopreserved in UW solution containing fetal bovine serum, dimethyl sulfoxide, and vitamin E remained highly transducible with lentiviral vector after thawing. When thawed, transduced in suspension, and immediately transplanted into the spleen of immunodeficient mice, ex vivo lentivirally transgene marked xenogeneic hepatocytes were detected in murine liver. We demonstrated that porcine hepatocytes are highly susceptible to lentiviral vector and describe an easy methodology to efficiently, rapidly, and stably introduce transgenes into uncultured porcine hepatocytes.

Long-term Results of Radical Resection for Locally Advanced Duodenal Adenocarcinoma

Hepato-gastroenterology. Nov-Dec, 2005  |  Pubmed ID: 16334766

Duodenal adenocarcinomas are uncommon tumors characterized by non-specific symptoms and late diagnosis. The objective of this study was to assess long-term results of locally advanced duodenal adenocarcinoma treated by surgical resection.

Islet Transplantation: Steeple Chase and the Next Hurdle

Transplantation. Dec, 2005  |  Pubmed ID: 16378056

Surgical Management of Abdominal and Retroperitoneal Castleman's Disease

World Journal of Surgical Oncology. Jun, 2005  |  Pubmed ID: 15941478

Abdominal and retroperitoneal Castleman's disease could present either as a localized disease or as a systemic disease. Castleman's disease is a lymphoid hyperplasia related to human Herpes virus type 8, which could have an aggressive behavior, similar to that of malignant lymphoid neoplasm mainly with the systemic type, or a benign one in its localized form.

Pancreas Allocation in the Era of Islet Transplantation

Transplant International : Official Journal of the European Society for Organ Transplantation. Jul, 2005  |  Pubmed ID: 15948853

Preoperative Concomitant Hyperfractionated Radiotherapy and Gemcitabine for Locally Advanced Rectal Cancers: a Phase I-II Trial

Cancer Journal (Sudbury, Mass.). Mar-Apr, 2005  |  Pubmed ID: 15969988

The purpose of this study was to determine the maximum tolerated dose of gemcitabine when it was administered concomitantly with hyperfractionated radiotherapy before surgery in patients with locally advanced rectal cancers and to investigate the midterm efficacy of such a regimen.

Islet Transplantation in a Recipient Presenting the Factor V Leiden Mutation

Transplantation. Jun, 2005  |  Pubmed ID: 15973190

Expression and Secretion of Alpha1-proteinase Inhibitor Are Regulated by Proinflammatory Cytokines in Human Pancreatic Islet Cells

Diabetologia. Aug, 2005  |  Pubmed ID: 16001235

Alpha1-proteinase inhibitor (alpha1-PI) has been considered a key player in inflammatory processes. In humans, the main production site of alpha1-PI is the liver, but other tissues, including pancreatic islets, also synthesise this molecule. The aims of this study were to assess the islet cell types that produce alpha1-PI, to determine whether alpha1-PI is actually secreted by islet cells, and to assess how its production and/or secretion are regulated.

Xenotransplantation: an Update on Recent Progress and Future Perspectives

Transplant International : Official Journal of the European Society for Organ Transplantation. Aug, 2005  |  Pubmed ID: 16008737

Currently, the number of patients awaiting transplantation is continuously increasing, and shortage of available deceased organ donors is the major limitation for organ and cell allotransplantation. Research to develop alternative sources of tissues is ongoing and xenogeneic organs or cells represent an attractive solution. This review focuses on recent progress achieved in this field, including the development of newly genetically modified animal donors and new immunosuppressive approaches. As xenotransplantation is moving closer to clinical application, future perspectives must establish guidelines to ensure that future clinical trials are carried out ethically and safely.

[University Collaboration]

Revue Médicale Suisse. Jun, 2005  |  Pubmed ID: 16028703

Surgical Treatment of Appendiceal Adenocarcinoid (goblet Cell Carcinoid)

World Journal of Surgery. Nov, 2005  |  Pubmed ID: 16136284

Adenocarcinoid of the appendix is an infrequent tumor with histologic features of both adenocarcinoma and carcinoid tumor. Although its malignant potential remains unclear, adenocarcinoids seem to be biologically more aggressive than conventional carcinoids. The aim of this study was to analyze long-term results of surgical treatment for appendiceal adenocarcinoid. A retrospective review (1991-2003) identified seven patients (median age 72, range 27-81 years) treated for appendiceal adenocarcinoid. The clinical data of these patients were reviewed. Follow-up was complete for all patients (median 60 months, range 24-108 months). Most cases presented with associated acute appendicitis (71%). First intention surgery consisted of appendectomy (m = 6) and right hemicolectomy (m = 1). In three patients, additional surgical procedures were performed (right colectomy). Indications for colectomy were tumor size (three cases) associated with appendectomy margin invasion in one case. One patient with lymph node and peritoneal involvement experienced recurrence 9 months after hemicolectomy and died of the disease at 2 years. One patient subsequently died of colon carcinoma 6 years after adenocarcinoid treatment. Five patients were alive without disease at the time of the last follow-up. Synchronous or metachronous colon carcinomas developed in three patients (43%). Our results suggest that appendectomy alone could be used for appendiceal adenocarcinoid provided that the tumor (1) is less than 1 cm; (2) does not extend beyond the appendix adventitia; (3) has less than 2 mitoses/10 high power fields; and (4) has surgical margins that are tumor free. Otherwise, carcinologic right colectomy seems to be indicated. The risk for developing colorectal adenocarcinoma seems to be extremely high in patients treated for appendiceal adenocarcinoid and warrants close follow-up with colonoscopic screening.

Neoadjuvant Radiochemotherapy for Locally Advanced Gastric Cancer: Long-term Results of a Phase I Trial

International Journal of Radiation Oncology, Biology, Physics. Dec, 2005  |  Pubmed ID: 16137836

To assess the long-term results of radiation therapy (RT) when added preoperatively to systemic chemotherapy in patients with locally advanced gastric cancer.

Treatment of Acetaminophen-induced Acute Liver Failure in the Mouse with Conditionally Immortalized Human Hepatocytes

Journal of Hepatology. Dec, 2005  |  Pubmed ID: 16169114

Liver failure is a life threatening condition currently treated by palliative measures and, when applicable, organ transplantation. The use of a bioartificial organ capable of fulfilling the main functions of the liver would represent an attractive alternative. However, the shortage of suitable donor cells, and their limited growth ability have impeded the development of this strategy. We investigated whether lentiviral vectors allow for conditional immortalization of human hepatocytes and whether these immortalized hepatocytes could reverse lethal acute liver failure.

Treatment of Fulminant Liver Failure by Transplantation of Microencapsulated Primary or Immortalized Xenogeneic Hepatocytes

Xenotransplantation. Nov, 2005  |  Pubmed ID: 16202069

The aim of this study was to evaluate in vitro and in vivo functions of isolated hepatocytes after immortalization, cryopreservation, encapsulation and xenotransplantation into mice with fulminant liver failure (FLF).

Impairment of Renal Function After Islet Transplant Alone or Islet-after-kidney Transplantation Using a Sirolimus/tacrolimus-based Immunosuppressive Regimen

Transplant International : Official Journal of the European Society for Organ Transplantation. Nov, 2005  |  Pubmed ID: 16221151

The immunosuppressive (IS) regimen based on sirolimus/low-dose tacrolimus is considered a major determinant of success of the Edmonton protocol. This regimen is generally considered safe or even protective for the kidney. Herein, we analyzed the impact of the sirolimus/low-dose tacrolimus combination on kidney function. The medical charts of islet transplant recipients with at least 6 months follow up were reviewed. There were five islet-after-kidney and five islet transplantation alone patients. Serum creatinin, albuminuria, metabolic control markers and graft function were analyzed. Impairment of kidney function was observed in six of 10 patients. Neither metabolic markers nor IS drugs levels were significantly associated with the decrease of kidney function. Although a specific etiology was not identified, some subsets of patients presented a higher risk for decline of kidney function. Low creatinin clearance, albuminuria and long-established kidney graft were associated with poorer outcome.

Management of Hepatocellular Adenoma: Solitary-uncomplicated, Multiple and Ruptured Tumors

World Journal of Gastroenterology : WJG. Sep, 2005  |  Pubmed ID: 16237767

While hepatocellular adenomas (HAs) have often been studied as a unique entity, we aimed to better define current management of the various forms of HAs.

The Duration of Postoperative Ileus After Elective Colectomy is Correlated to Surgical Specialization

International Journal of Colorectal Disease. Sep, 2006  |  Pubmed ID: 16267669

Postoperative ileus is an important factor of complications following gastrointestinal procedures. Its pathophysiology and the parameters, which may impact on its duration, remain unclear. The aim of this study was to measure the role of various clinical determinants on restoration of intestinal function after elective colorectal surgery.

Morphologic Alterations Associated with Mechanical Bowel Preparation Before Elective Colorectal Surgery: a Randomized Trial

Diseases of the Colon and Rectum. Jan, 2006  |  Pubmed ID: 16273330

The feasibility and safety of left-sided colorectal procedures with avoidance of mechanical bowel preparation has recently been demonstrated. Moreover, mechanical preparation has been associated with an increased risk for abdominal septic complications, including anastomotic leakage. This study was designed to determine whether mechanical bowel preparation is associated with histologic alterations in the colon.

Endothelial Nitric Oxide Synthase Regulation is Altered in Pancreas from Cirrhotic Rats

World Journal of Gastroenterology : WJG. Jan, 2006  |  Pubmed ID: 16482622

To determine whether biliary cirrhosis could induce pancreatic dysfunction such as modifications in endothelial nitric oxide synthase(eNOS) expression and whether the regulation of eNOS could be altered by the regulatory proteins caveolin and heat shock protein 90 (Hsp90), as well as by the modifications of calmodulin binding to eNOS.

Notice of Duplicate Publication: "Mechanical Bowel Preparation for Elective Colorectal Surgery: a Meta-analysis" (Arch Surg. 2004;139:1359-1364)

Archives of Surgery (Chicago, Ill. : 1960). Feb, 2006  |  Pubmed ID: 16490904

Epidural Anaesthesia Restores Pancreatic Microcirculation and Decreases the Severity of Acute Pancreatitis

World Journal of Gastroenterology : WJG. Feb, 2006  |  Pubmed ID: 16521220

To investigate the effect of epidural anaesthesia (EA) on pancreatic microcirculation during acute pancreatitis (AP).

Neutrophil Depletion--but Not Prevention of Kupffer Cell Activation--decreases the Severity of Cerulein-induced Acute Pancreatitis

World Journal of Gastroenterology : WJG. Feb, 2006  |  Pubmed ID: 16534874

To determine whether neutrophil depletion and Kupffer cell inhibition might combine their protective effects to decrease the severity of acute pancreatitis.

Long-term Renal Function After Liver Transplantation is Related to Calcineurin Inhibitors Blood Levels

Clinical Transplantation. Jan-Feb, 2006  |  Pubmed ID: 16556162

Renal dysfunction is common after liver transplantation (LT). The aim of our study was to assess the prevalence of renal dysfunction 5 yr after LT and to identify risk factors for the development of this complication.

Soluble CD40 Ligand in Prediction of Acute Severe Pancreatitis

World Journal of Gastroenterology : WJG. Mar, 2006  |  Pubmed ID: 16570356

To assess the early predictability of the soluble CD40L (sCD40L) in pancreatitis severity.

Outcome of Surgery for Rectal Cancer in Octogenarians

Swiss Medical Weekly. Mar, 2006  |  Pubmed ID: 16633966

The aim of this study was to assess the outcome of surgery for rectal cancer in patients 80 years of age or more.

Lymph Node Retrieval in Abdominoperineal Surgical Specimen is Radiation Time-dependent

World Journal of Surgical Oncology. 2006  |  Pubmed ID: 16749931

A low yield of lymph nodes (LN) in abdominoperineal resection (APR) specimen has been associated with preoperative radiation therapy (XRT) in population-based studies, which may preclude adequate staging of anorectal carcinomas. We hypothesized that the number of LN retrieved in APR specimen was correlated with the dose and the timing of pelvic irradiation.

International Trial of the Edmonton Protocol for Islet Transplantation

The New England Journal of Medicine. Sep, 2006  |  Pubmed ID: 17005949

Islet transplantation offers the potential to improve glycemic control in a subgroup of patients with type 1 diabetes mellitus who are disabled by refractory hypoglycemia. We conducted an international, multicenter trial to explore the feasibility and reproducibility of islet transplantation with the use of a single common protocol (the Edmonton protocol).

Tetracycline-regulated Expression of VEGF-A in Beta Cells Induces Angiogenesis: Improvement of Engraftment Following Transplantation

Cell Transplantation. 2006  |  Pubmed ID: 17176614

Early revascularization of pancreatic islet cells after transplantation is crucial for engraftment, and it has been suggested that vascular endothelial growth factor-A (VEGF-A) plays a significant role in this process. Although VEGF gene therapy can improve angiogenesis, uncontrolled VEGF secretion can lead to vascular tumor formation. Here we have explored the role of temporal VEGF expression, controlled by a tetracycline (TC)-regulated promoter, on revascularization and engraftment of genetically modified beta cells following transplantation. To this end, we modified the CDM3D beta cell line using a lentiviral vector to promote secretion of VEGF-A either in a TC-regulated (TET cells) or a constitutive (PGK cells) manner. VEGF secretion, angiogenesis, cell proliferation, and stimulated insulin secretion were assessed in vitro. VEGF secretion was increased in TET and PGK cells, and VEGF delivery resulted in angiogenesis, whereas addition of TC inhibited these processes. Insulin secretion by the three cell types was similar. We used a syngeneic mouse model of transplantation to assess the effects of this controlled VEGF expression in vivo. Time to normoglycemia, intraperitoneal glucose tolerance test, graft vascular density, and cellular mass were evaluated. Increased expression of VEGF resulted in significantly better revascularization and engraftment after transplantation when compared to control cells. In vivo, there was a significant increase in vascular density in grafted TET and PGK cells versus control cells. Moreover, the time for diabetic mice to return to normoglycemia and the stimulated plasma glucose clearance were also significantly accelerated in mice transplanted with TET and PGK cells when compared to control cells. VEGF was only needed during the first 2-3 weeks after transplantation; when removed, normoglycemia and graft vascularization were maintained. TC-treated mice grafted with TC-treated cells failed to restore normoglycemia. This approach allowed us to switch off VEGF secretion when the desired effects had been achieved. TC-regulated temporal expression of VEGF using a gene therapy approach presents a novel way to improve early revascularization and engraftment after islet cell transplantation.

Successful Treatment of Recurrent Focal Segmental Glomerulosclerosis After Kidney Transplantation by Plasmapheresis and Rituximab

Transplant International : Official Journal of the European Society for Organ Transplantation. Jan, 2007  |  Pubmed ID: 17181660

A 22-year-old patient whose primary kidney disease was focal segmental glomerulosclerosis (FSGS) developed severe recurrence of proteinuria (up to 57 g/24 h) immediately after a haploidentic living donor kidney transplantation despite pre-operative plasmapheresis. The immunosuppressive treatment consisted of tacrolimus, mycophenolate mofetil, basiliximab and steroids. He underwent 10 plasmapheresis sessions in the first 3-week post-transplantation. In addition, he received 2 i.v. doses of rituximab (RTX) 600 mg (375 mg/m(2)) on days 7 and 15. Proteinuria decreased below nephrotic range at day 14 and serum creatinine returned progressively to normal values. A short course of oral ciclophosphamide (100 mg/j) was administrated between days 22 and 40 and three additional plasmapheresis sessions on days 34, 39 and 49. This strategy allowed obtaining sustained full remission of the nephrotic syndrome (NS) and excellent graft function, which persists over 2 years after transplantation. No notable adverse events related to RTX or plasmapheresis were observed. This case suggests that RTX associated with plasmapheresis may be an effective treatment of recurrent NS because of FSGS.

Hemorrhagic Shock Caused by Rupture of an Intra-abdominal Leydig Cell Tumour: Case Report

Case Reports in Gastroenterology. 2007  |  Pubmed ID: 21487472

The rupture of an intra-abdominal testicular neoplasm is a rare cause of acute abdomen and massive intra-abdominal haemorrhage. We report the case of a 70-year-old male presenting a massive intra-abdominal bleeding caused by a Leydig cell tumour in an undescended testis. The clinical details and pathology of this rare testicular tumour are discussed.

Should Preoperative Mechanical Bowel Preparation Be Abandoned?

Annals of Surgery. Apr, 2007  |  Pubmed ID: 17414618

Conversion to Sirolimus-based Immunosuppression in Maintenance Liver Transplantation Patients

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. May, 2007  |  Pubmed ID: 17457887

Sirolimus (SRL) has been proposed to replace calcineurin inhibitors (CNI) in case of CNI-induced toxicity. The aim of this study was to evaluate the efficacy and safety of conversion from CNI to SRL in maintenance liver transplantation (LT) patients. Between 2002 and 2006, conversion was performed in 48 patients (17 female, 31 male; mean age 57 +/- 10 yr) after a median delay of 19.4 months (range 0.2-173 months) after LT. Indication for conversion was renal impairment (RI) (78%), CNI neurotoxicity (13%), or post-LT cancer (9%). Median follow-up was 22.6 +/- 11 months. Median SRL dosage and trough levels were 2.4 +/- 1.3 mg and 8.1 +/- 2.7 microg/L. Immunosuppression consisted of SRL alone (33%), or SRL + mycophenolate mofetil (MMF) (39%), SRL + prednisone (15%), SRL + CNI (4%), or SRL + MMF + prednisone (8%). Mean glomerular filtration rate (GFR) improved from 33 to 48 mL/minute in patients with severe RI (P = 0.022) and from 56 to 74 mL/minute in patients with moderate RI (P = 0.0001). After conversion, main complications were albuminuria (36%), hyperlipidemia (49%), dermatitis (14%), edema (14%), oral ulcers (12%), joint pain (4%), infection (2%), and pneumonia (2%). Acute rejection (AR) occurred in 17% of the patients. SRL was withdrawn in 17% of the patients. In conclusion, conversion from CNI to SRL is safe and is associated with significant renal function improvement.

Lessons Learned from One Thousand Consecutive Colonic Resections in a Teaching Hospital

Swiss Medical Weekly. May, 2007  |  Pubmed ID: 17557216

Elective colectomies are standard procedures carrying below 1% mortality; by contrast, emergency colonic resections remain surgical challenges in compromised and/or elderly patients and are associated with high complication rates.

A Simple Score for Predicting Alcohol Relapse After Liver Transplantation: Results from 387 Patients over 15 Years

Archives of Internal Medicine. Jun, 2007  |  Pubmed ID: 17563028

Alcohol relapse can negatively influence the outcome after liver transplantation (LT). The aim of our study was to identify factors that could be associated with the recurrence of harmful alcohol consumption after LT.

Multimedia Article. Laparoscopic Repair of Parastomal Hernia Using a Porcine Dermal Collagen (Permacol) Implant

Diseases of the Colon and Rectum. Sep, 2007  |  Pubmed ID: 17619220

Surgical repair of parastomal hernias is usually performed through a laparotomy (stoma translocation) or a peristomal incision (mesh repair). Laparoscopic approach may minimize the risks of mesh infection and, thus, represents an attractive alternative. Permacol (Tissue Science Laboratories plc, Aldershot, Hampshire, U.K.) is a new biomaterial implant, which combines the strength and biocompatibility.

Expectations and Strategies Regarding Islet Transplantation: Metabolic Data from the GRAGIL 2 Trial

Transplantation. Jul, 2007  |  Pubmed ID: 17627243

Whether islet transplantation should be aimed at restoring insulin independence or providing adequate metabolic control is still debated. The GRAGIL2 trial was designed as a phase 1-2 study where primary outcome was the rate of insulin independence, and secondary outcome was the success rate defined by a composite score based upon basal C-peptide, HbA1c, hypoglycemic events, and exogenous insulin needs.

Long-term Results of Surgical Treatment of Vater's Ampulla Neoplasms

Hepato-gastroenterology. Jun, 2007  |  Pubmed ID: 17629078

Vater's ampulla neoplasms account for 30% of resected bilio-pancreatic confluent tumors. Study aim was to review long-term results of surgical treatment for ampullary neoplasms.

Results of Conservative Treatment for Perforated Gastroduodenal Ulcers in Patients Not Eligible for Surgical Repair

Swiss Medical Weekly. Jun, 2007  |  Pubmed ID: 17629803

Conservative treatment of perforated gastroduodenal ulcer has been shown to be associated with good results in patients whose general condition is good. However, its use in patients not eligible for surgical repair has not been supported. The aim of this study is to evaluate the results of conservative treatment in these patients in the era of proton pump inhibitor.

A New Disposable Perfusion Machine, Nuclear Magnetic Resonance Compatible, to Test the Marginal Organs and the Kidneys from Non-heart-beating Donors Before Transplantation

Interactive Cardiovascular and Thoracic Surgery. Aug, 2007  |  Pubmed ID: 17669888

This article is the first report about our new hypothermic pulsatile perfusion machine (HUG's HPP-machine) for kidney perfusion. This machine will be used for (31)P NMR spectroscopy. The aim is to obtain scores of viability of marginal kidneys and those from non-heart-beating donors (NHBD) before transplantation using HPP as it has been demonstrated necessary in these situations. The most predictable test is the ratio of phosphomonoester on inorganic phosphorus (PME/Pi) that can be obtained from (31)P spectroscopy. The machine has been built to allow perfusion of kidneys in the range of that performed with the traditional Belzer, Mox-Waters machines and others, but compatible with the magnetic fields of the MRI apparatus used for (31)P NMR spectroscopy. In this publication, the technical aspects of this new aerobic HPP-machine compatible with MRI is presented.

[The Evolution of Surgery]

Revue Médicale Suisse. Jun, 2007  |  Pubmed ID: 17708228

[The Da Vinci Surgical System in Digestive Surgery]

Revue Médicale Suisse. Jun, 2007  |  Pubmed ID: 17708229

Since 1990, laparoscopy and minimally invasive techniques in general, have been widely adopted in the field of digestive surgery. However, due to its technical limitations, the use of conventional laparoscopy remains limited to procedures of low (cholecystectomy, appendectomy) or intermediate (Nissen fundoplication, sigmoidectomy) complexity. This paper reviews the technical aspects of the da Vinci robot, as well as its potential applications to digestive surgery. While robotic-assisted cholecystectomy and fundoplication are feasible, this approach is not superior to conventional laparoscopy; by contrast, preliminary data suggest that robotic-assisted surgery might be superior to laparoscopy in more complex procedures, such as gastric bypass and total mesorectum excision for rectal cancer.

[Islet Autotransplantation to Prevent Diabetes After Pancreatectomy for Benign Disease of the Pancreas]

Revue Médicale Suisse. Jun, 2007  |  Pubmed ID: 17708230

Patients with benign pancreatic disease (chronic pancreatitis, benign tumors) requiring extensive pancreatic surgery are subject to major metabolic changes. Many of them are at risk of developing diabetes. Surgical diabetes is very difficult to manage because of the lack of counter regulation mechanisms. Islet autotransplantation after isolation from the resected pancreas allows to avoid the development of surgical diabetes. Insulin independance can be maintained in 40 to 50% of the patients. Success rate depends on the number of isolated and transplanted islets and on the type of pancreatic disease. Procedures-related complications are rare, the most frequent being thrombosis of the portal vein, through which the islets are transplanted. Islet autotransplantation has been used successfully in chronic pancreatitis and benign tumors.

[Xenotransplantation, Soon a Clinical Reality?]

Revue Médicale Suisse. Jun, 2007  |  Pubmed ID: 17708231

Organ transplantation has encountered great development during the 80's. However, the number of organ donations and transplantations performed stabilized during the 90ies, with a concomitant increase of patients on the waiting list. Xenotransplantation, i.e. the use of animal organs for transplantation to humans, is one among various alternatives to human organ donation. Xenotransplantation offers several advantages, e.g. it would be possible to transplant all patients at an early stage of their disease. The main barriers to xenotransplantation are the strong immunological responses that human develop against animal antigens and zoonoses. To overcome these hurdles, genetically modified pigs have been engineered by cloning and could allow the initiation of new clinical trials in a near future.

[Congenital Asplenia (Ivemark Syndrome) Revealed by Mesenteric Vein Thrombosis in a 77 Year Old Patient]

Gastroentérologie Clinique Et Biologique. Oct, 2007  |  Pubmed ID: 18166867

Congenital asplenia (Ivemark syndrome) is usually associated with major cardiac malformations, which determine the clinical presentation and often result in death before 6 months of age. We report the unusual case of a 77 year-old patient with a congenital asplenia that was incidentally detected during a laparotomy for mesenteric vein thrombosis. The other abnormal findings in the abdomen were a para-esophageal hiatal hernia and left kidney hypotrophy. A segmental resection of the mid-jejunum was performed, with uneventful recovery. A thoraco-abdominal CT scan failed to reveal any associated vascular malformations in the retroperitoneum or the thorax. This case suggests that, in some instances, congenital asplenia, when isolated, may remain asymptomatic and be compatible with a long, and functionally normal life.

A New Method of Biliary Sampling for Cytopathological Examination During Endoscopic Retrograde Cholangiography

The American Journal of Gastroenterology. Mar, 2007  |  Pubmed ID: 17156144

Biliary brushing during endoscopic retrograde cholangiography (ERC) may allow the diagnosis of cancer, but this technique is limited by a low (18-57%) sensitivity. We compared the cellular and diagnostic yields of a new sampling method (using stricture dilation and a grasping basket) with those of brushing.

[Liver Disease in Obese Patients]

Revue Médicale Suisse. Sep, 2007  |  Pubmed ID: 17918488

Due to obesity epidemics, nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are becoming the main causes of chronic liver disease in western countries. Nonalcoholic steatohepatitis is a potentially progressive disease that may cause cirrhosis. We analysed liver histology in 505 patients at the time of gastric by-pass surgery. Steatosis was present in 92% of these patients, mild (< 30% of hepatocytes) in 46%, moderate (30-60% of hepatocytes) in 30%, and severe in 23%. Insulin resistance, diabetes, elevated ferritin and elevated liver tests were independent predictors of NASH in the liver these obese patients. Early identification of these factors might help to select patients at risk of NASH in whom liver biopsy should be considered.

A Prospective Longitudinal Evaluation of Quality of Life After Abdominoperineal Resection

Journal of Surgical Oncology. Jan, 2008  |  Pubmed ID: 17929253

Abdominoperineal resection (APR) is a disfiguring procedure, frequently associated with significant urogenital dysfunction. The aim of this prospective study was to repeatedly assess quality of life (QoL) 1, 6, and 12 months after APR.

Totally Intracorporeal Laparoscopic Colorectal Anastomosis Using Circular Stapler

Surgical Endoscopy. May, 2008  |  Pubmed ID: 17943355

A number of surgical techniques for colorectal anastomosis have been described for laparoscopic left-sided colectomies. Due to the complexity of these procedures, open preparation of the proximal bowel for circular stapler anastomosis through a Pfannenstiel incision has become the gold standard. We report a new laparoscopic technique for totally intracorporeal colorectal circular anastomosis (TLCCA) using a circular stapler.

Incidence, Consequences, and Risk Factors for Anastomotic Dehiscence After Colorectal Surgery: a Prospective Monocentric Study

International Journal of Colorectal Disease. Mar, 2008  |  Pubmed ID: 18034250

Anastomotic dehiscence is the most severe surgical complication after large bowel resection. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with anastomotic leakage after colorectal surgery.

T0 N1 Adenocarcinoma of the Colon Following Oxaliplatin-based Neoadjuvant Chemotherapy

Journal of Surgical Oncology. Jan, 2008  |  Pubmed ID: 18085621

Computer-assisted Digital Image Analysis to Quantify the Mass and Purity of Isolated Human Islets Before Transplantation

Transplantation. Dec, 2008  |  Pubmed ID: 19077896

Accurate determination of islet purity and mass before transplantation is an essential part of quality control. The standard method is based on manual evaluation of these parameters and thus subjective and prone to errors. Therefore, we developed a computerized approach aimed at evaluating more objectively the number and purity of isolated human islets.

'Liver First' Approach in the Treatment of Colorectal Cancer with Synchronous Liver Metastases

Digestive Surgery. 2008  |  Pubmed ID: 19212115

In patients with synchronous colorectal liver metastases, an approach reversing the traditional therapeutic order - i.e. starting with chemotherapy first, doing the liver surgery second, and performing the colorectal surgery last - is theoretically appealing as it avoids the risk of metastatic progression during treatment of the primary tumor. The present series updates on a previously reported pilot experience.

Pyoderma Gangrenosum After Totally Implanted Central Venous Access Device Insertion

World Journal of Surgical Oncology. 2008  |  Pubmed ID: 18325095

Pyoderma gangrenosum is an aseptic skin disease. The ulcerative form of pyoderma gangrenosum is characterized by a rapidly progressing painful irregular and undermined bordered necrotic ulcer. The aetiology of pyoderma gangrenosum remains unclear. In about 70% of cases, it is associated with a systemic disorder, most often inflammatory bowel disease, haematological disease or arthritis. In 25-50% of cases, a triggering factor such as recent surgery or trauma is identified. Treatment consists of local and systemic approaches. Systemic steroids are generally used first. If the lesions are refractory, steroids are combined with other immunosuppressive therapy or to antimicrobial agents.

Minimally Invasive Necrosectomy for Infected Necrotizing Pancreatitis

Pancreas. Mar, 2008  |  Pubmed ID: 18376300

Infected necrotizing pancreatitis represents a serious and therapeutically challenging complication. Percutaneous drainage of infected pancreatic necrosis is often unsuccessful. Alternatively, open necrosectomies are associated with high morbidity. Recently, minimally invasive necrosectomy techniques have been tried with satisfying results; however, they frequently necessitate multiple sessions for definitive necrosectomy. To evaluate results of single large-port laparoscopic necrosectomy for proven infected necrotizing pancreatitis.

Spontaneous Rupture of a Gastrointestinal Stromal Tumour Associated with Life-threatening Nontraumatic Hemoperitoneum

Canadian Journal of Surgery. Journal Canadien De Chirurgie. Apr, 2008  |  Pubmed ID: 18377739

Mesenchymal Stem Cells Derived from Human Exocrine Pancreas Express Transcription Factors Implicated in Beta-cell Development

Pancreas. Jul, 2008  |  Pubmed ID: 18580448

Transplantation of in vitro generated islets or insulin-producing cells represents an attractive option to overcome organ shortage. The aim of this study was to isolate, expand, and characterize cells from human exocrine pancreas and analyze their potential to differentiate into beta cells.

Single Port Access Laparoscopic Right Hemicolectomy

International Journal of Colorectal Disease. Oct, 2008  |  Pubmed ID: 18607608

Single port access (SPA) surgery is a rapidly evolving field as it combines some of the cosmetic advantage of the Natural Orifice Translumenal Endoscopic Surgery (NOTES) and allows performing surgical procedure with standard surgical instruments. We report in this paper a new technique of umbilical SPA right hemicolectomy with conventional surgical oncologic principle and technique of minimally invasive colectomy.

Low Risk of Anti-human Leukocyte Antigen Antibody Sensitization After Combined Kidney and Islet Transplantation

Transplantation. Jul, 2008  |  Pubmed ID: 18645502

Anti-human leukocyte antigen (HLA) antibody could lead to humoral rejection and a decrease in graft survival after kidney transplantation. A recent report has suggested that islet transplantation alone is associated with a high rate of sensitization. The withdrawal of the immunosuppressive therapy because of the progressive nonfunction of the islets could explain the high rate of sensitization. Because the specific risk of immunization of multiple islet infusions remains unknown, we studied the immunization rate in our cohort of multiple islet infusions transplant recipients. De novo anti-HLA antibodies were analyzed in 37 patients after islets alone (n=8), islet-after-kidney (n=13), and simultaneous islet-kidney (n=16) transplantation by solid phase assays over time. The rate of immunization was 10.8% that is comparable with the risk of immunization after kidney transplantation alone. Multiple islet infusions do not represent a specific risk for the development of anti-HLA antibodies after combined kidney-islets transplantation.

Organ Preservation in Pancreas and Islet Transplantation

Current Opinion in Organ Transplantation. Feb, 2008  |  Pubmed ID: 18660708

Organ preservation aims at reducing ischemia-reperfusion injury and maintains or even improves its function, and, therefore, increases transplant safety and efficiency. With the chronic lack of organs for transplantation, marginal donors are more and more frequently used in Western countries. New challenges, therefore, have to be met in organ preservation.

Management of Malignant Pleural Effusion and Ascites by a Triple Access Multi Perforated Large Diameter Catheter Port System

World Journal of Surgical Oncology. 2008  |  Pubmed ID: 18706116

Pleural or peritoneal effusions (ascites) are frequent in terminal stage malignancies. Medical management may be hazardous.

Results of Emergency Hartmann's Operation for Obstructive or Perforated Left-sided Colorectal Cancer

World Journal of Surgical Oncology. 2008  |  Pubmed ID: 18721476

Up to 15% of colorectal cancer (CRC) patients present with obstructive or perforated tumours, and require emergency surgery. The Hartmann's procedure (HP) provides the opportunity to achieve a potentially curative (R0) resection, while minimizing surgical trauma in poor-risk patients. The aim of this study was to assess the surgical (operative mortality), and oncological (long-term survival after curative resection) results of emergency HP for obstructive or perforated left-sided CRC.

Who Should Do NOTES? Initial Endoscopic Performance of Laparoscopic Surgeons Compared to Gastroenterologists and Untrained Individuals

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Oct, 2008  |  Pubmed ID: 18726133

Natural orifice transluminal endoscopic surgery (NOTES) is a multidisciplinary surgical technique. If conventional endoscopic instrumentation can be easily mastered, surgeons with laparoscopic experience could head NOTES interventions.

Diagnosis and Management of Anal Cancer

Current Gastroenterology Reports. Oct, 2008  |  Pubmed ID: 18799127

During the past three decades, anal cancer has served as a paradigm for the successful application of chemoradiation to solid tumors. Since the early 1990s, the increasing incidence of anal cancer in homosexual men has highlighted the causative role of oncogenic human papilloma-virus infection. This review focuses on significant trends and developments in the management of patients with squamous cell carcinoma of the anal canal, emphasizing three major aspects of diagnosis and treatment: routine screening and eradication of premalignant lesions in high-risk individuals; outcome of chemoradiation therapy in HIV-positive individuals in the era of highly active antiretroviral therapy; and potential improvements in chemoradiation protocols through improved radiation delivery technique and the combination of mitomycin with cisplatin in current prospective randomized trials.

The Role of Macrophage Migration Inhibitory Factor in Mouse Islet Transplantation

Transplantation. Nov, 2008  |  Pubmed ID: 19034004

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine produced by many tissues including pancreatic beta-cells.

Grasp or Brush for Biliary Sampling at Endoscopic Retrograde Cholangiography? A Blinded Randomized Controlled Trial

The American Journal of Gastroenterology. Feb, 2008  |  Pubmed ID: 17900324

Brushing, the standard sampling method at endoscopic retrograde cholangiography (ERC), lacks sensitivity for cancer detection. We assessed a novel sampling method using a grasping basket.

Improved Long-term Outcome of Surgery for Advanced Colorectal Liver Metastases: Reasons and Implications for Management on the Basis of a Severity Score

Annals of Surgical Oncology. Jan, 2008  |  Pubmed ID: 17909911

The outcome of liver resection for colorectal liver metastases (CRLM) appears to be improving despite the fact that surgery is offered to patients with more-severe disease. To quantify this assumption and to understand its causes we analyzed a series of patients on the basis of a standardized severity score and changes in management occurring over the years.

Independent Evolution of Heart Autonomic Function and Insulin Sensitivity During Weight Loss

Obesity (Silver Spring, Md.). Feb, 2009  |  Pubmed ID: 19039318

In order to investigate the improvement of insulin resistance and cardiac autonomic function along massive weight loss, 12 obese women were evaluated before, and 3 and 12 months after Roux-en-Y gastric bypass. The 12-month values were compared to those of BMI-matched controls. Insulin sensitivity was assessed by euglycemic clamp and the cardiac autonomic function by the analysis of the Heart Rate Variability (HRV). After surgery, glucose uptake progressively increased from 4.3 +/- 0.5 mg/kg lean body mass (LBM)/min preoperative (pre-op) to 4.9 +/- 0.5 and 7.0 +/- 0.5, 3- and 12-month postoperative (post-op) (P = 0.04 and P = 0.006 vs. pre-op), whereas the cardiac autonomic function showed a biphasic pattern. HRV values increased 3 months post-op, and decreased at 12 months, thus indicating an early sympathetic withdrawal followed by a later reactivation (e.g., the standard deviation of the normal-to-normal intervals was 116 +/- 7 ms in pre-op, 161 +/- 10 at 3 months, P = 0.008 vs. pre-op, and 146 +/- 15 at 12 months, P = 0.03 vs. pre-op and P = 0.02 vs. 3 m). Insulin sensitivity was significantly related to body weight (P = 0.02), whereas the cardiac indexes were significantly linked to the profile of energy intake (e.g., HRV triangular index vs. energy intake P = 0.003). No significant relationship linked insulin sensitivity to the cardiac autonomic indexes. Insulin sensitivity and cardiac parameters of the 12-month post-op patients were similar to their matched controls. During massive weight loss, the cardiac autonomic deregulation and insulin resistance improved concomitantly but independently from each other. Our results suggest that the extent of the improvement is associated with the final body weight.

Laparoscopic Treatment of Mucinous Urachal Adenocarcinoma with Mucocele

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. Feb, 2009  |  Pubmed ID: 19238053

We present a case of an asymptomatic 76-year-old woman treated laparoscopically for an urachal mucocele owing to a nonmetastatic urachal mucinous adenocarcinoma. Since laparoscopic en bloc resection of the urachus and partial cystectomy, the patient has been healthy and disease-free for 12 months. Modern surgical treatment of urachal adenocarcinoma is discussed in the light of this case.

Role of GM-CSF Signaling in Cell-based Tumor Immunization

Blood. Jun, 2009  |  Pubmed ID: 19282460

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a potent adjuvant in cancer vaccination; however, the specific role of endogenous GM-CSF remains unknown. We performed cell-based vaccination in 2 tumor models. First, we vaccinated C57BL/6 mice lacking either GM-CSF, IL-5, or beta-common chain (betac), a receptor subunit essential for GM-CSF and IL-5 signaling, with melanoma cells engineered to produce GM-CSF. Tumor vaccination was effective in both GM-CSF(-/-) and IL-5(-/-) mice, showing that protective immunization is independent of both endogenous cytokines. However, all betac(-/-) animals developed tumor. Loss of tumor immunity in betac(-/-) mice does not reflect global impairment in cell-mediated immunity, as contact hypersensitivity reaction to haptens is unaltered. The importance of tumor cell-derived GM-CSF was highlighted by recruitment of dendritic cells at the vaccination site in wild-type, GM-CSF(-/-), and IL-5(-/-) but not in betac(-/-) mice. In the second model, vaccination with unmodified RENCA cells showed similar results with efficient immunization in BALB/c wild-type and GM-CSF(-/-), whereas all betac(-/-) animals died. Altogether, our results strongly suggest that although endogenous GM-CSF and IL-5 are not required to induce tumor immunity, signaling through betac receptor is critically needed for efficient cancer vaccination in both genetically modified GM-CSF-secreting tumor cells and a spontaneously immunogenic models.

What Clinical Alternatives to Whole Liver Transplantation? Current Status of Artificial Devices and Hepatocyte Transplantation

Transplantation. Feb, 2009  |  Pubmed ID: 19307780

Shortage of organ donors limits the number of possible liver transplantations. Alternative therapies for treatment of liver failure are currently being developed: (i) extracorporeal artificial liver devices; (ii) bioartificial liver devices using hepatocytes; and (iii) hepatocyte transplantation. The objective of these strategies is to bridge patients with liver failure until a suitable liver allograft is obtained for transplantation or the patient's own liver regenerates sufficiently to resume normal function. In this review, we discuss these strategies and summarize the current status of clinical experience.

Functional Outcome and Quality of Life After Restorative Proctocolectomy and Ileo-anal Pouch Anastomosis

Swiss Medical Weekly. Apr, 2009  |  Pubmed ID: 19350425

Reconstructive proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the surgical treatment of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). The aim of our study was to evaluate the functional results of this procedure and to assess its impact upon patient quality of life (QoL).

Molecular Aspects of Intestinal Radiation-induced Fibrosis

Current Molecular Medicine. Apr, 2009  |  Pubmed ID: 19355909

Radiation therapy is a key component of the management of various pelvic tumors, including prostate, gynecological, and anorectal carcinomas. Unfortunately, normal tissues located in the vicinity of target organs are radiosensitive, and long-term cancer survivors may develop late treatment-related injury, most notably radiation-induced fibrosis (RIF) of the small bowel. The cellular mediators of intestinal fibrosis are mesenchymal cells (i.e. myofibroblasts, fibroblasts and smooth muscle cells) which, when activated, serve as the primary collagen-producing cells, and are responsible for excess deposition of extracellular matrix components, eventually leading to intestinal loss of function. For decades, the underlying mechanisms involved in chronic activation of myofibroblasts within the normal tissues were unknown, and the fibrotic process, which ensued, was considered irreversible. Recent advances in the pathogenesis of RIF have demonstrated prolonged upregulation of fibrogenic cytokines, such as Transforming growth factor-beta1 (TGF-beta1) and its main downstream effector, Connective tissue growth factor (CTGF), in the myofibroblasts of irradiated small bowel. TGF-beta1-mediated activation of CTGF gene expression is controlled by Smads, but recently Rho/ROCK signaling has emerged as an alternative pathway involved in the control of CTGF expression in intestinal fibrosis. This article underlines the clinical relevance of RIF as it relates to damage to the small bowel, provides insight to its molecular biology, and finally unveils the potential role of Rho-ROCK inhibitors as emerging strategies to promote RIF reversal.

Prevention, Chemoradiation and Surgery for Anal Cancer

Expert Review of Anticancer Therapy. Apr, 2009  |  Pubmed ID: 19374601

Management of patients with squamous cell carcinoma of the anus (SCCA) has remained virtually unchanged since the 1980s. By contrast, the demographics of SCCA are evolving, with the emergence of a high-risk group of patients: HIV-positive male homosexuals are prone to develop anal intra-epithelial neoplasia and rapidly progress towards invasive SCCA. By many aspects, anal cancer is similar to uterine cervix cancer - a sexually transmitted disease driven by oncogenic human papillomavirus (HPV) infection. Thus, for many patients, SCCA results from the combination of two preventable diseases, HPV and HIV infection. This article reviews current evidence suggesting that a new, more preventive approach is needed in order to improve the clinical outcome of SCCA in HIV-positive patients.

Immunomodulation by Blockade of the TRANCE Co-stimulatory Pathway in Murine Allogeneic Islet Transplantation

Transplant International : Official Journal of the European Society for Organ Transplantation. Sep, 2009  |  Pubmed ID: 19453995

We explore herein the effect of TNF-related activation-induced cytokine (TRANCE) co-stimulatory pathway blockade on islet survival after allograft transplantation. Expression of TRANCE on murine C57Bl/6 (B6) CD4+ T cells after allogeneic activation was analyzed by fluorescence-activated cell sorter (FACS). The effect of a TRANCE receptor fusion protein (TR-Fc) and anti-CD154 antibody (MR1) on B6 spleen cell proliferation after allogeneic activation was assessed by mixed lymphocyte reaction (MLR). Three groups of B6 mice were transplanted with allogeneic islets (DBA2): Control; short-term TR-Fc-treatment (days 0-4); and prolonged TR-Fc-treatment (days -1 to 13). Donor-specific transfusion (DST) was performed at the time of islet transplantation in one independent experiment. Transplantectomy samples were analyzed by immunohistochemistry. TRANCE expression was upregulated in stimulated CD4+ T cells in vitro. In MLR experiments, TR-Fc and MR1 both reduced spleen cell proliferation, but less than the combination of both molecules. Short-course TR-Fc treatment did not prolong islet graft survival when compared with controls (10.6 +/- 1.9 vs. 10.7 +/- 1.5 days) in contrast to prolonged treatment (20.7 +/- 3.2 days; P < 0.05). After DST, primary non function (PNF) was observed in half of control mice, but never in TR-Fc-treated mice. Immunofluorescence staining for Mac-1 showed a clear decrease in macrophage recruitment in the treated groups. TRANCE-targeting may be an effective strategy for the prolongation of allogeneic islet graft survival, thanks to its inhibitory effects on co-stimulatory signals and macrophage recruitment.

Impact of IQ, Computer-gaming Skills, General Dexterity, and Laparoscopic Experience on Performance with the Da Vinci Surgical System

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Sep, 2009  |  Pubmed ID: 19455549

Due to improved ergonomics and dexterity, robotic surgery is promoted as being easily performed by surgeons with no special skills necessary. We tested this hypothesis by measuring IQ elements, computer gaming skills, general dexterity with chopsticks, and evaluating laparoscopic experience in correlation to performance ability with the da Vinci robot.

Transumbilical Single-incision Laparoscopic Intracorporeal Anastomosis for Gastrojejunostomy: Case Report

Surgical Endoscopy. Jul, 2009  |  Pubmed ID: 19466494

Laparoscopic gastrojejunostomy allows effective palliation and rapid recovery for the patient with limited survival due to advanced pancreatic cancer presenting with gastric outlet obstruction. Transumbilical single-incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. The authors report the first transumbilical single-incision laparoscopic intracorporeal anastomosis for gastrojejunostomy.

Improved Survival of Fulminant Liver Failure by Transplantation of Microencapsulated Cryopreserved Porcine Hepatocytes in Mice

Cell Transplantation. 2009  |  Pubmed ID: 19476213

The aim of this study was to establish hepatocyte isolation in pigs, and to evaluate function of isolated hepatocytes after encapsulation, cryopreservation, and transplantation (Tx) in a mouse model of fulminant liver failure (FLF). After isolation, porcine hepatocytes were microencapsulated with alginate-poly-L-Lysine-alginate membranes and cryopreserved. In vitro, albumin production of free and encapsulated hepatocytes were measured by enzyme linked-immunoadsorbent assay. In vivo, encapsulated hepatocytes were transplanted into different groups of mice with FLF and the following experimental groups were performed: group 1, Tx of empty capsules; group 2, Tx of free primary porcine hepatocytes; group 3, Tx of fresh encapsulated porcine hepatocytes; group 4, Tx of cryopreserved encapsulated porcine hepatocytes. In vitro, fresh or cryopreserved encapsulated porcine hepatocytes showed a continuous decreasing metabolic function over 1 week (albumin and urea synthesis, drug catabolism). In vivo, groups 1 and 2 showed similar survival (18% and 25%, respectively, p > 0.05). In groups 3 and 4, Tx of fresh or cryopreserved encapsulated porcine hepatocytes significantly increased survival rate to 75% and 68%, respectively (p < 0.05). Primary porcine hepatocytes maintained metabolic functions after encapsulation and cryopreservation. In mice with FLF, Tx of encapsulated xenogeneic hepatocytes significantly improved survival. These results indicate that porcine hepatocytes can successfully be isolated, encapsulated, stored using cryopreservation, and transplanted into xenogeneic recipients with liver failure and sustain liver metabolic functions.

[Pancreas and Islets of Langerhans Transplantation: Current Status in 2009 and Perspectives]

Revue Médicale Suisse. Jun, 2009  |  Pubmed ID: 19579422

Type 1 diabetes currently affects 15,000 patients in Switzerland with a rising incidence worldwide. Pancreas or islet of Langerhans transplantation are alternatives to intensive insulin treatment, which decreases long-term complications at the cost of an increase of severe hyoglycemia. Pancreas transplantation, indicated mainly to diabetic patients with simultaneous kidney transplantation, has a high success rate, but is accompanied by high morbidity due to general surgery. Islet transplantation, a cell-therapy for type 1 diabetes, is in full development. It is mainly indicated as islet transplant alone in patients suffering from brittle diabetes, and is associated with a very low risk due to minimally invasive technique, but a lower rate of long-term success. New potential sources of beta cell replacement are beta-cell lines, stem cells and xenotransplantation.

Regulated Laminin-332 Expression in Human Islets of Langerhans

FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology. Dec, 2009  |  Pubmed ID: 19667121

Laminin-332 (LN-332) is a basement membrane component known to exert a beneficial effect on rat pancreatic beta cells in vitro. In this work, we analyzed the expression of LN-332 in human islets, its expression after inflammatory insults by cytokines, and the molecular mechanisms responsible for this effect. By Western blotting and RT-PCR, we showed that LN-332 was expressed in isolated human islets. By immunofluorescence on pancreas sections, we observed that labeling was confined to endocrine cells in islets. Confocal microscopy analysis on isolated islet cells revealed that labeling was granular but did not colocalize with hormone secretory granules. LN-332 was most abundant in cultured islets compared to freshly isolated islets and was found in culture medium, which suggests that it was secreted by islets. When islets were exposed to interleukin (IL)-1beta, expression and secretion of LN-332 increased as compared to control. No effect was observed with tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. LY294002, an inhibitor of phosphatidylinositol 3-kinase (PI3-K) activity, inhibited culture- and IL-1beta-induced LN-332 expression in islets. These results show that LN-332, known to have some beneficial effect on beta cells in vitro, is produced and secreted by endocrine islet cells and is up-regulated by stressing conditions such as culture and IL-1beta-exposure.

Fibrogenic Potential of Human Multipotent Mesenchymal Stromal Cells in Injured Liver

PloS One. 2009  |  Pubmed ID: 19684854

Multipotent mesenchymal stromal cells (MSC) are currently investigated clinically as cellular therapy for a variety of diseases. Differentiation of MSC toward endodermal lineages, including hepatocytes and their therapeutic effect on fibrosis has been described but remains controversial. Recent evidence attributed a fibrotic potential to MSC. As differentiation potential might be dependent of donor age, we studied MSC derived from adult and pediatric human bone marrow and their potential to differentiate into hepatocytes or myofibroblasts in vitro and in vivo. Following characterization, expanded adult and pediatric MSC were co-cultured with a human hepatoma cell line, Huh-7, in a hepatogenic differentiation medium containing Hepatocyte growth factor, Fibroblast growth factor 4 and oncostatin M. In vivo, MSC were transplanted into spleen or liver of NOD/SCID mice undergoing partial hepatectomy and retrorsine treatment. Expression of mesenchymal and hepatic markers was analyzed by RT-PCR, Western blot and immunohistochemistry. In vitro, adult and pediatric MSC expressed characteristic surface antigens of MSC. Expansion capacity of pediatric MSC was significantly higher when compared to adult MSC. In co-culture with Huh-7 cells in hepatogenic differentiation medium, albumin expression was more frequently detected in pediatric MSC (5/8 experiments) when compared to adult MSC (2/10 experiments). However, in such condition pediatric MSC expressed alpha smooth muscle more strongly than adult MSC. Stable engraftment in the liver was not achieved after intrasplenic injection of pediatric or adult MSC. After intrahepatic injection, MSC permanently remained in liver tissue, kept a mesenchymal morphology and expressed vimentin and alpha smooth muscle actin, but no hepatic markers. Further, MSC localization merges with collagen deposition in transplanted liver and no difference was observed using adult or pediatric MSC. In conclusion, when transplanted into an injured or regenerating liver, MSC differentiated into myofibroblasts with development of fibrous tissue, regardless of donor age. These results indicate that MSC in certain circumstances might be harmful due to their fibrogenic potential and this should be considered before potential use of MSC for cell therapy.

Single-port Access Laparoscopic Radical Left Colectomy in Humans

Diseases of the Colon and Rectum. Oct, 2009  |  Pubmed ID: 19966617

Transumbilical single-port access (SPA) surgery is a rapidly evolving field that combines in part the cosmetic advantage of natural orifice transluminal endoscopic surgery (NOTES) with the ability to perform the operation with standard laparoscopic instruments. We report our experience with the first transumbilical single-port access radical left colectomy conforming to surgical oncologic principle and minimally invasive colectomy technique.

Phlegmonous Colitis: Another Source of Sepsis in Cirrhotic Patients?

BMC Gastroenterology. 2009  |  Pubmed ID: 20003486

The clinical relevance of phlegmonous colitis (PC), a rare autopsy finding in cirrhotic patients, is poorly documented. We postulated that PC might be a source of sepsis in patients with portal hypertensive colopathy (PHC).

Single Port Access Laparoscopic Cholecystectomy (with Video)

World Journal of Surgery. May, 2009  |  Pubmed ID: 19116734

Single port access (SPA) surgery is a rapidly evolving field due to the complexity of NOTES (natural orifice translumenal endoscopic surgery). SPA combines the cosmetic advantage of NOTES and possibility to perform surgical procedure with standard laparoscopic instruments. We report a technique of umbilical SPA cholecystectomy using standard laparoscopic instruments and complying with conventional surgical principle and technique of minimally invasive cholecystectomy.

Perforated Meckel's Diverticulitis Complicating Active Crohn's Ileitis: a Case Report

Journal of Medical Case Reports. 2009  |  Pubmed ID: 19144118

In Crohn's disease, the extension of active terminal ileitis into a Meckel's diverticulum is possible, but usually has no impact on clinical decision-making. We describe an original surgical approach in a young woman presenting with a combination of perforated Meckel's diverticulitis and active Crohn's ileitis.

Transrectal Natural Orifice Transluminal Endoscopic Surgery for Umbilical Hernia Repair in a Human Cadaver (with Video)

Gastrointestinal Endoscopy. May, 2009  |  Pubmed ID: 19152890

E-NOTES Appendectomy Versus Transvaginal Appendectomy: Similar Cosmetic Results but Shorter Complete Recovery?

Surgical Endoscopy. Apr, 2009  |  Pubmed ID: 19184218

Unusual Masses of the Pancreas to Be Aware Of

Case Reports in Gastroenterology. 2009  |  Pubmed ID: 21103259

This paper aims at emphasizing the difficulty in assessing preoperatively the diagnosis of solid masses of the pancreas whatever the initial clinical presentation may be. We illustrate our purpose describing consecutive cases of pancreatic masses of the pancreas we recently had and who were followed according to the internal guidelines of investigation of our referral hospital. Whereas malignant tumors of the pancreas represent the vast majority of solid tumors of the pancreas, other diagnoses must be evoked. We report three cases of pancreatic solid masses that were explored by endoscopic ultrasonography coupled with fine needle aspiration, a method universally considered to be both reliable and accurate but which failed to assess definitive diagnosis due to both cytological pitfalls and sampling error.

International Human Xenotransplantation Inventory

Transplantation. Sep, 2010  |  Pubmed ID: 20644502

Xenotransplantation carries inherent risks of infectious disease transmission to the recipient and even to society at large, and it should only be carried out with strict regulation and oversight. In collaboration with the International Xenotransplantation Association, the University Hospital Geneva, and the World Health Organization, an international inventory has been established (www.humanxenotransplant.org) aiming to collect basic data on all types of currently ongoing or recently performed xenotransplantation procedures in humans.

Assessment of Human Islet Labeling with Clinical Grade Iron Nanoparticles Prior to Transplantation for Graft Monitoring by MRI

Cell Transplantation. 2010  |  Pubmed ID: 20719068

Ex vivo labeling of islets with superparamagnetic iron oxide (SPIO) nanoparticles allows posttransplant MRI imaging of the graft. In the present study, we compare two clinical grade SPIOs (ferucarbotran and ferumoxide) in terms of toxicity, islet cellular uptake, and MRI imaging. Human islets (80-90% purity) were incubated for 24 h with various concentrations of SPIOs (14-280 μg/ml of iron). Static incubations were performed, comparing insulin response to basal (2.8 mM) or high glucose stimulation (16.7 mM), with or without cAMP stimulation. Insulin and Perl's (assessment of iron content) staining were performed. Electronic microscopy analysis was performed. Labeled islets were used for in vitro or in vivo imaging in MRI 1.5T. Liver section after organ removal was performed in the same plane as MRI imaging to get a correlation between histology and radiology. Postlabeling islet viability (80 ± 10%) and function (in vitro static incubation and in vivo engraftment of human islets in nude mice) were similar in both groups. Iron uptake assessed by electron microscopy showed iron inclusions within the islets with ferucarbotran, but not with ferumoxide. MRI imaging (1.5T) of phantoms and of human islets transplanted in rats, demonstrated a strong signal with ferucarbotran, but only a weak signal with ferumoxide. Signal persisted for >8 weeks in the absence of rejection. An excellent correlation was observed between radiologic images and histology. The hepatic clearance of intraportally injected ferucarbotran was faster than that of ferumoxide, generating less background. A rapid signal decrease was observed in rejecting xenogeneic islets. According to the present data, ferucarbotran is the most appropriate of available clinical grade SPIOs for human islet imaging.

Robotic Single-incision Transabdominal and Transvaginal Surgery: Initial Experience with Intersecting Robotic Arms

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Sep, 2010  |  Pubmed ID: 20812266

Single-incision laparoscopic and natural orifice translumenal endoscopic surgery (NOTES) are technically challenging methods. Robotics might have the potential to overcome such hurdles with computer technology.

Robotic Hip Arthroscopy in Human Anatomy

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Sep, 2010  |  Pubmed ID: 20812270

Robotic technology offers technical advantages that might offer new solutions for hip arthroscopy.

[When Should a Patient with Headaches Be Referred to the Emergency Ward?]

Revue Médicale Suisse. Aug, 2010  |  Pubmed ID: 20873430

Secondary headaches are rare though potentially severe. A systematic search of red flags helps to suspect headaches of secondary origin that require further urgent investigation. Main red flags are: sudden onset, exceptionally severe headache, new headache in patient over 50, vomiting or syncope, focal neurological sign or neck stiffness, recent trauma, uncommon headache during pregnancy or anticoagulant therapy, suspicion of glaucoma.

Detection and Management of Bile Duct Stones

Gastrointestinal Endoscopy. Oct, 2010  |  Pubmed ID: 20883860

Management of Obstructive and Perforated Colorectal Cancer

Expert Review of Anticancer Therapy. Oct, 2010  |  Pubmed ID: 20942632

Colorectal cancer frequently presents with obstruction or perforation at the time of diagnosis, and requires urgent surgery. Various surgical and endoscopic approaches are available that minimize the risk of complications related to emergency colorectal operations and optimize the oncological outcome for the patients. The surgeon has to make clinically and oncologically adequate decisions, ranging from diverting colostomy to partial or total colectomy in a one-stage procedure or multistage interventions. The endoscopic insertion of a self-expanding metallic stent is an option either as a definitive procedure in palliative conditions or as a bridge to safer elective surgery. In this article, we discuss the current surgical and endoscopic treatments of complicated colorectal cancer and propose an algorithm for the management of patients with obstructive tumors.

Transplantation of Mouse Embryonic Stem Cells Induces Hematopoietic and Tissue Chimerism in Rats

Xenotransplantation. Sep-Oct, 2010  |  Pubmed ID: 20973278

Embryonic stem cells (ESC) can differentiate into all cell lineages, and ESC-like cells were shown to induce hematopoietic chimerism and tolerance in allogeneic models. The aim of our study was to test the capacity of mouse ESC (mESC) to engraft in rats in a xenotransplantation setting. Forty-six rats were transplanted intravenously with 1 million mESC, without immunosuppression (group 1, n = 23) or with cyclosporine (group 2, n = 23). Three months after mESC transplantation, skin grafts were performed from allogeneic, xenogeneic identical to mESC, or xenogeneic third party donors. At day 27 post-transplant, we detected circulating mouse cells in the blood of 4/23 and 5/23 animals of group 1 and group 2, respectively. Chimerism was confirmed by PCR. We also identified long-term surviving murine cells within livers of chimeric animals. Skin grafts showed no difference in survival between allogeneic and xenogeneic donors. Transplantation of xenogeneic mouse ESC induced short-term chimerism in the blood and persistent tissue chimerism in the liver of recipient rats, but did not induce tolerance to skin grafts. Improved immunosuppressive protocols should be tested to prolong chimerism and allow tolerance.

Set-up and Docking of the Da Vinci Surgical System: Prospective Analysis of Initial Experience

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Mar, 2010  |  Pubmed ID: 20047195

Set-up and docking of the da Vinci surgical system are assumed to extend overall operating times. We hypothesized that these tasks could be achieved in adequate times. Therefore, a prospective analysis of set-up and docking times of the da Vinci Surgical System was conducted.

Laparoscoendoscopic Single-site Cholecystectomy and Occult Gallbladder Cancer

Surgical Endoscopy. Jul, 2010  |  Pubmed ID: 20054569

Vascular Invasion in Pancreatic Cancer: Imaging Modalities, Preoperative Diagnosis and Surgical Management

World Journal of Gastroenterology : WJG. Feb, 2010  |  Pubmed ID: 20143460

Pancreatic cancer is associated with a poor prognosis, and surgical resection remains the only chance for curative therapy. In the absence of metastatic disease, which would preclude resection, assessment of vascular invasion is an important parameter for determining resectability of pancreatic cancer. A frequent error is to misdiagnose an involved major vessel. Obviously, surgical exploration with pathological examination remains the "gold standard" in terms of evaluation of resectability, especially from the point of view of vascular involvement. However, current imaging modalities have improved and allow detection of vascular invasion with more accuracy. A venous resection in pancreatic cancer is a feasible technique and relatively reliable. Nevertheless, a survival benefit is not achieved by curative resection in patients with pancreatic cancer and vascular invasion. Although the discovery of an arterial invasion during the operation might require an aggressive management, discovery before the operation should be considered as a contraindication. Detection of vascular invasion remains one of the most important challenges in pancreatic surgery. The aim of this article is to provide a complete review of the different imaging modalities in the detection of vascular invasion in pancreatic cancer.

Unique Arrangement of Alpha- and Beta-cells in Human Islets of Langerhans

Diabetes. May, 2010  |  Pubmed ID: 20185817

It is generally admitted that the endocrine cell organization in human islets is different from that of rodent islets. However, a clear description of human islet architecture has not yet been reported. The aim of this work was to describe our observations on the arrangement of human islet cells.

Spontaneous Dissection of the Superior Mesenteric Artery and the Right Hepatic Artery: a Case Report

Journal of Medical Case Reports. 2010  |  Pubmed ID: 20233417

Isolated spontaneous dissection of the superior mesenteric artery is a very rare condition. Endovascular stent placement has been proposed recently for selected cases, which has led to some good clinical results.

Neoadjuvant Chemotherapy in Patients with Stage IV Colorectal Cancer: a Comparison of Histological Response in Liver Metastases, Primary Tumors, and Regional Lymph Nodes

Annals of Surgical Oncology. Oct, 2010  |  Pubmed ID: 20405223

We report the histopathological results of a novel "inversed" strategy designed to manage patients with colorectal cancer (CRC) who have synchronous liver metastases by using chemotherapy first, liver surgery second, and resection of the primary tumor as a final step. This study was designed to compare the response to chemotherapy in liver metastases, primary tumors, and locoregional lymph nodes.

Anti-CD154 MAb and Rapamycin Induce T Regulatory Cell Mediated Tolerance in Rat-to-mouse Islet Transplantation

PloS One. 2010  |  Pubmed ID: 20436684

Anti-CD154 (MR1) monoclonal antibody (mAb) and rapamycin (RAPA) treatment both improve survival of rat-to-mouse islet xenograft. The present study investigated the effect of combined RAPA/MR1 treatment on rat-to-mouse islet xenograft survival and analyzed the role of CD4(+)CD25(+)Foxp3(+) T regulatory cells (Treg) in the induction and maintenance of the ensuing tolerance.

Robot-assisted Oncologic Resection for Large Gastric Gastrointestinal Stromal Tumor: a Preliminary Case Series

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. Jun, 2010  |  Pubmed ID: 20459328

Laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) has been shown as feasible and safe in terms of oncologic results. However, laparoscopic resection has been demonstrated to be mainly suitable for small, favorably localized GIST. The robotic approach may, by its characteristics, enable the surgeon to perform atypical gastrectomies in an unfavorable location (i.e., close to pylorus or cardia). Its use in oncologic gastric surgery has been poorly defined and has never been reported for GIST.

Calcifying Bowel Inflammation: a Case Report

Gastroenterology Research and Practice. 2010  |  Pubmed ID: 20490272

We report about a previously healthy 72-year-old woman, presented with 6 days of left lower quadrant abdominal pain and constipation. There was no report of fever, melena, hematochezia or change in appetite. The physical exam demonstrated a distended abdomen with palpable left lower quadrant pain, without guarding. CT showed images compatible with a sigmoid diverticulitis and a calcification of the sigmoid colon. After antibiotic threatment, a colonoscopy was performed which revealed the presence of a shell in the sigmoid colon. Our case illustrates the need for a colonoscopy following an attack of diverticulitis to look for a cancer or rarely a foreign body.

A Prospective, Randomized, Single-blind Comparison of Laparoscopic Versus Open Sigmoid Colectomy for Diverticulitis

Annals of Surgery. Jul, 2010  |  Pubmed ID: 20505508

The aim of this study was to compare open and laparoscopic sigmoid resection for diverticulitis with the patient and the nursing staff blinded to the surgical approach.

Predicting Survival After Pulmonary Metastasectomy for Colorectal Cancer: Previous Liver Metastases Matter

BMC Surgery. 2010  |  Pubmed ID: 20525275

Few patients with lung metastases from colorectal cancer (CRC) are candidates for surgical therapy with a curative intent, and it is currently impossible to identify those who may benefit the most from thoracotomy. The aim of this study was to determine the impact of various parameters on survival after pulmonary metastasectomy for CRC.

Segmental Duodenectomy for Gastrointestinal Stromal Tumor of the Duodenum

World Journal of Gastroenterology : WJG. Jun, 2010  |  Pubmed ID: 20533599

To evaluate the results of segmental duodenectomy (SD) and pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumor (GIST) and help clinicians with surgical management.

Macrophage Migration Inhibitory Factor Deficiency Leads to Age-dependent Impairment of Glucose Homeostasis in Mice

The Journal of Endocrinology. Sep, 2010  |  Pubmed ID: 20566490

Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine produced by many cells and tissues including pancreatic beta-cells, liver, skeletal muscle, and adipocytes. This study investigates the potential role of MIF in carbohydrate homeostasis in a physiological setting outside of severe inflammation, utilizing Mif knockout (MIF-/-) mice. Compared with wild-type (WT) mice, MIF-/- mice had a lower body weight, from birth until 4 months of age, but subsequently gained weight faster, resulting in a higher body weight at 12 months of age. The lower weight in young mice was related to a higher energy expenditure, and the higher weight in older mice was related to an increased food intake and a higher fat mass. Fasting blood insulin level was higher in MIF-/- mice compared with WT mice at any age. After i.p. glucose injection, the elevation of blood insulin level was higher in MIF-/- mice compared with WT mice, at 2 months of age, but was lower in 12-month-old MIF-/- mice. As a result, the glucose clearance during intraperitoneal glucose tolerance tests was higher in MIF-/- mice compared with WT mice until 4 months of age, and was lower in 12-month-old MIF-/- mice. Insulin resistance was estimated (euglycemic-hyperinsulinemic clamp tests), and the phosphorylation activity of AKT was similar in MIF-/- mice and WT mice. In conclusion, this mouse model provides evidence for the role of MIF in the control of glucose homeostasis.

From Single-port Access to Laparoendoscopic Single-site Cholecystectomy

Surgical Endoscopy. Jan, 2010  |  Pubmed ID: 19688398

Injection Drug Use Before and After Liver Transplantation: a Retrospective Multicenter Analysis on Incidence and Outcome

Clinical Transplantation. Jul-Aug, 2010  |  Pubmed ID: 19849705

Injecting drug use (IDU) before and after liver transplantation (LT) is poorly described. The aim of this study was to quantify relapse and survival in this population and to describe the causes of mortality after LT.

Hepatitis C Virus Infection After Liver Transplantation is Associated with Lower Levels of Activated CD4(+)CD25(+)CD45RO(+)IL-7ralpha(high) T Cells

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. Jan, 2010  |  Pubmed ID: 19866484

The expression of interleukin 7 receptor alpha(high) (IL-7Ralpha(high)) discriminates between activated CD25(+)CD45RO(+)CD4(+) T cells [IL-7Ralpha(high) and forkhead box P3-negative (FoxP3(-))] and regulatory T cells (IL-7Ralpha(low) and FoxP3(+)). The IL-7Ralpha(high)CD25(+)CD45RO(+)CD4(+)FoxP3(-) T cell population has been shown to be expanded in the blood and tissues of patients after kidney transplantation and to contain alloreactive T cells (activated T cells). In the present study, we analyzed the distribution of IL-7Ralpha(high)CD25(+)CD45RO(+)CD4(+)FoxP3(-) T cells in the blood of 53 patients after liver transplantation. The IL-7Ralpha(high)CD25(+)CD45RO(+)CD4(+)FoxP3(-) T cell population was significantly expanded (P < 0.0001) in stable transplant recipients versus healthy donors. However, the magnitude of the expansion was significantly higher (P < 0.0001) in liver transplant recipients with no hepatitis C virus (HCV) infection in comparison with those with a preexisting HCV infection. Interestingly, effective suppression of HCV viremia after antiviral therapy was associated with an increase in the IL-7Ralpha(high)CD25(+)CD45RO(+)CD4(+)FoxP3(-) T cell population to levels comparable to those of liver transplant recipients not infected with HCV. The present results indicate that (1) the IL-7Ralpha(high)CD25(+)CD45RO(+)CD4(+)FoxP3(-) T cell population is expanded after liver transplantation, (2) it is a valuable immunological marker for monitoring activated and potential alloreactive CD4 T cells in liver transplantation, and (3) a preexisting HCV infection negatively influences the expansion of this population in liver transplant recipients.

Computed Tomography of Complicated Meckel's Diverticulum in Adults: a Pictorial Review

Insights into Imaging. May, 2010  |  Pubmed ID: 22347905

OBJECTIVE: To show various CT aspects of complicated Meckel's diverticulum in adult patients to facilitate the preoperative diagnosis of this rare pathology in emergency settings. METHODS: A computer search of medical records over a 15 year period identified 23 adult patients who underwent surgery for acute abdomen generated by a complicated Meckel's diverticulum. CT images available for review were analyzed, and some specific patterns leading to the diagnosis of complicated Meckel's diverticulum are presented in this review. RESULTS: Complications were related to inflammation (14 patients), bleeding (5 patients), intestinal obstruction (3 patients), and penetrating foreign body (1 patient). The presence of a Meckel's diverticulum was usually suggested at CT scan by an abnormal outpouching, blind-ending digestive structure connected to the terminal ileum by a neck of variable caliber. Depending on the type of complications, the diverticulum was surrounded by mesenteric inflammatory changes, or presented as a localized fluid or air-fluid collection contiguous with the terminal ileum. The diverticulum was also the source of active bleeding or acted as the lead point to intestinal obstruction or intussusception. CONCLUSION: CT findings of complicated Meckel's diverticulum are polymorphic and should be considered in the evaluation of adult patients with acute abdomen.

Augmented Reality and Image Overlay Navigation with OsiriX in Laparoscopic and Robotic Surgery: Not Only a Matter of Fashion

Journal of Hepato-biliary-pancreatic Sciences. Jul, 2011  |  Pubmed ID: 21487758

New technologies can considerably improve preoperative planning, enhance the surgeon's skill and simplify the approach to complex procedures. Augmented reality techniques, robot assisted operations and computer assisted navigation tools will become increasingly important in surgery and in residents' education.

Current Situation of Donation After Circulatory Death in European Countries

Transplant International : Official Journal of the European Society for Organ Transplantation. Jul, 2011  |  Pubmed ID: 21504489

The aim of the present study was to describe the current situation of donation after circulatory death (DCD) in the Council of Europe, through a dedicated survey. Of 27 participating countries, only 10 confirmed any DCD activity, the highest one being described in Belgium, the Netherlands and the United Kingdom (mainly controlled) and France and Spain (mainly uncontrolled). During 2000-2009, as DCD increased, donation after brain death (DBD) decreased about 20% in the three countries with a predominant controlled DCD activity, while DBD had increased in the majority of European countries. The number of organs recovered and transplanted per DCD increased along time, although it remained substantially lower compared with DBD. During 2000-2008, 5004 organs were transplanted from DCD (4261 kidneys, 505 livers, 157 lungs and 81 pancreas). Short-term outcomes of 2343 kidney recipients from controlled versus 649 from uncontrolled DCD were analyzed: primary non function occurred in 5% vs. 6.4% (P = NS) and delayed graft function in 50.2% vs. 75.7% (P < 0.001). In spite of this, 1 year graft survival was 85.9% vs. 88.9% (P = 0.04), respectively. DCD is increasingly accepted in Europe but still limited to a few countries. Controlled DCD might negatively impact DBD activity. The degree of utilization of DCD is lower compared with DBD. Short-term results of DCD are promising with differences between kidney recipients transplanted from controlled versus uncontrolled DCD, an observation to be further analyzed.

Intestinal Obstruction Following Use of Laparoscopic Barbed Suture: a New Complication with New Material?

Minimally Invasive Therapy & Allied Technologies : MITAT : Official Journal of the Society for Minimally Invasive Therapy. Dec, 2011  |  Pubmed ID: 22145693

Small bowel obstruction is a common pathology. Among the various etiologies, foreign material has been incriminated as a possible but uncommon cause. Recently, barbed suture has been successfully introduced in various surgical fields and has been reported as safe as standard suture. We report herein a case of intestinal obstruction due to the laparoscopic use of barbed suture during a promontofixation. Barbed suture has the risk of entrapping the small bowel. The surgeon should keep in mind this hypothetical problem and a high index of suspicion is needed to diagnose and treat quickly this potentially severe complication.

Population Perception of Surgical Safety and Body Image Trauma: a Plea for Scarless Surgery?

Surgical Endoscopy. Feb, 2011  |  Pubmed ID: 20602141

Laparoendoscopic single-site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES) are prospected as the future of minimally invasive surgery. While scarless surgery (NOTES and LESS) is gaining increasing popularity, perception of these approaches should be investigated.

Detecting Rejection After Mouse Islet Transplantation Utilizing Islet Protein-stimulated ELISPOT

Cell Transplantation. 2011  |  Pubmed ID: 21054945

Improved posttransplant monitoring and on-time detection of rejection could improve islet transplantation outcome. The present study explored the possibility of detecting harmful events after mouse islet transplantation measuring the immune responsiveness against islet extracts. Mouse islet transplantations were performed using various donor/recipient combinations, exploring autoimmune (NOD/SCID to NOD, n = 6) and alloimmune events (C57BL/6 to BALB/c, n = 20), a combination of both (C57BL/6 to NOD, n = 8), the absence of both (BALB/c to BALB/c, n = 21), or naive, nontransplanted control mice (n = 14). The immune reactivity was measured by ELISPOT, looking at the ex vivo release of IFN-γ from splenocytes stimulated by islet donor extracts (sonicated islets). The immune reactivity was not altered in the syngeneic and autoimmune models, demonstrating similar levels as nontransplanted controls (p = 0.46 and p = 0.6). Conversely, the occurrence of an allogeneic rejection alone or in combination to autoimmunity was associated to an increase in the level of immune reactivity (p = 0.023 and p = 0.003 vs. respective controls). The observed increase was transient and lost in the postrejection period or after treatment with CTLA4-Ig. Overall, allogeneic rejection was associated to a transient increase in the reactivity of splenocytes against islet proteins. Such a strategy has the potential to improve islet graft monitoring in human and should be further explored.

Single-port Access Prosthetic Repair for Primary and Incisional Ventral Hernia: Toward Less Parietal Trauma

Surgical Endoscopy. Jun, 2011  |  Pubmed ID: 21136098

Although still under development, single-port access (SPA) approach may be of interest in patients prone to port-side incisional hernia, ensuring absence of increased fascial incision. This forms the basis for evaluating SPA for prosthetic ventral hernia repair. We report a new SPA technique of ventral hernia repair using working-channel endoscope, standard laparoscopic instruments, and 10-mm port.

Value of Contrast-enhanced 18F-fluorodeoxyglucose Positron Emission Tomography/computed Tomography in Detection and Presurgical Assessment of Pancreatic Cancer: a Prospective Study

Journal of Gastroenterology and Hepatology. Apr, 2011  |  Pubmed ID: 21155879

Positron Emission Tomography (PET) using (18)F-fluorodeoxyglucose (FDG) associated with computed tomography (CT) is increasingly used for the detection and the staging of pancreatic cancer, but data regarding its clinical added value in pre-surgical planning is still lacking. The aim of this study is to investigate the performance of FDG PET associated with contrast-enhanced CT in detection of pancreatic cancer.

Rapamycin Impairs Proliferation of Transplanted Islet β Cells

Transplantation. Apr, 2011  |  Pubmed ID: 21297554

The cause for a progressive attrition of islet graft function observed over the years after islet transplantation is not well defined but may be in part the result of adverse effects of immunosuppressive agents. In this study, we examined the effect of rapamycin, a key component of the immunosuppressive regimen, on β-cell replication of transplanted islets.

Female Population Perception of Conventional Laparoscopy, Transumbilical LESS, and Transvaginal NOTES for Cholecystectomy

Surgical Endoscopy. Jul, 2011  |  Pubmed ID: 21301884

Recent population survey has shown a preference for transumbilical laparoendoscopic single-site surgery (U-LESS) compared with natural orifice transluminal endoscopic surgery (NOTES) for cholecystectomy, assuming similar surgical risk. This study was designed to evaluate the perception and preference of women regarding conventional laparoscopy, U-LESS, and transvaginal NOTES (TV-NOTES) with particular interest to access perception.

The Impact of Waiting List Alpha-fetoprotein Changes on the Outcome of Liver Transplant for Hepatocellular Carcinoma

Journal of Hepatology. Oct, 2011  |  Pubmed ID: 21334400

Liver transplantation is a recognized treatment for selected patients with hepatocellular carcinoma (HCC), but transplant criteria still need to be refined, especially in the case of more advanced or downstaged tumors.

Influence of Donor Age on Islet Isolation and Transplantation Outcome

Transplantation. Feb, 2011  |  Pubmed ID: 21344706

It has been suggested that the age of human organ donors might influence islet isolation and transplantation outcome in a negative way due to a decrease of in vivo function in islets isolated from older donors.

Development of Laparoscopic Single-site Cholecystectomy Mandates Critical View of Safety Dissection and Routine Intraoperative Cholangiography

Journal of the American College of Surgeons. Mar, 2011  |  Pubmed ID: 21356492

Single Port Access Laparoscopic Cholecystectomy (with Video): Reply

World Journal of Surgery. May, 2011  |  Pubmed ID: 21359687

Choosing the Cosmetically Superior Laparoscopic Access to the Abdomen: the Importance of the Umbilicus

Surgical Endoscopy. Aug, 2011  |  Pubmed ID: 21359890

Single-incision laparoscopy (SIL) is a rapidly growing procedure in the field of surgery. The most frequent site of abdominal access is the umbilicus. Its appearance can be altered during SIL procedures. The literature suggests that the umbilicus plays an important role in the overall physical appearance of patients. This study therefore investigated the perception of the general population regarding the cosmetics of the umbilicus.

Islet Autotransplantation After Extended Pancreatectomy for Focal Benign Disease of the Pancreas

Transplantation. Apr, 2011  |  Pubmed ID: 21372755

Extended pancreatectomy is associated with the risk of surgical diabetes. Islet autotransplantation is successful in the prevention of diabetes after pancreas resection for chronic pancreatitis (CP), with insulin independence rates of 50% at 1 year. The aim of the present study is to demonstrate the safety and efficiency of islet autotransplantation after extended left pancreatectomy for benign disease.

Transplantation of Encapsulated Hepatocytes During Acute Liver Failure Improves Survival Without Stimulating Native Liver Regeneration

Cell Transplantation. Mar, 2011  |  Pubmed ID: 21396154

The aim of this study was to evaluate the effects of intraperitoneal transplantation of encapsulated human hepatocytes on liver metabolism and regeneration of mice with acute liver failure. Primary human hepatocytes were immortalized using lentiviral vectors coding for antiapoptotic genes and microencapsulated using alginate-polylysine polymers. In vitro, immortalized human hepatocytes showed low, but stable, synthetic and catabolitic functions over time, when compared to primary hepatocytes. In vivo, mice with acute liver failure and transplanted with encapsulated immortalized human hepatocytes had a significantly improved survival and biochemical profile, compared to mice transplanted with empty capsules. Serum levels of cytokines implicated in liver regeneration were lower in mice transplanted with hepatocytes compared to mice receiving empty capsules. This decrease was significant for IL-6 and HGF at 3 h. Measurement of liver regeneration showed no significant difference between mice transplanted with hepatocytes compared to control groups. Intraperitoneal transplantation of encapsulated immortalized hepatocytes significantly improved survival of mice with acute liver failure by providing metabolic support and without modifying liver regeneration. The lower levels of cytokines implicated in liver regeneration suggest that the metabolic support provided by the encapsulated hepatocytes reduced the inflammatory stress on the liver and herein decreased the regenerative trigger on residual hepatocytes. These data emphasize that metabolic function and regeneration of hepatocytes are two distinct aspects that need to be studied and approached separately during acute liver failure.

Laparoscopic Versus Open Sigmoid Resection for Diverticulitis: Long-term Results of a Prospective, Randomized Trial

Surgical Endoscopy. Oct, 2011  |  Pubmed ID: 21556992

Elective laparoscopic sigmoid resection for diverticulitis has proven short-term benefits, but little data are available from prospective randomized trials regarding long-term outcome, quality of life, and functional results.

Appendectomy During the Third Trimester of Pregnancy in a 27-year Old Patient: Case Report of a "near Miss" Complication

Patient Safety in Surgery. 2011  |  Pubmed ID: 21575272

The management of acute appendicitis during pregnancy is not fully established, especially regarding the choice between open and laparoscopic surgery during the third trimester. We report herein the case of a major uterine variecele hemorrhage during a laparoscopic appendectomy in a 27-year old pregnant patient at 33 weeks of amenorrhea. After conversion to a Pfannenstiel incision, the baby was delivered, the bleeding stopped and the appendectomy completed. While both mother and child fully recovered, this «near miss» complication underlines the challenges linked to the management of acute appendicitis during pregnancy. Based on a literature review, we propose an algorithm favoring the laparoscopic approach during the first and second trimesters, and the open approach during the third trimester (especially after the 26th week of amenorrhea). In case of unclear pre-operative diagnosis, a laparoscopy should be conducted even during the third trimester with a Mc Burney conversion when the diagnosis of appendicitis is confirmed.

Totally Robotic Right Colectomy: a Preliminary Case Series and an Overview of the Literature

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Jun, 2011  |  Pubmed ID: 21678543

BACKGROUND: Since the introduction of robotics, relatively few series have been published evaluating its role for right colectomy. The aim of this study was to report our preliminary experience with totally robotic right colectomy (TRRC). METHODS: Between 2009 and 2010 we performed three TRRCs, using a hand-sewn intracorporeal anastomosis. Data were retrospectively reviewed. RESULTS: Two women and one man underwent a TRRC. Mean operative time was 270 min. Mean blood loss was 30 ml. There was no conversion. Mean number of lymph nodes harvested was 18. There were no complications. Median hospital stay was 10 days. After a median follow-up of 10 months, there was no tumoural recurrence. CONCLUSION: TRRC is not only safe and feasible but also oncologically effective. Although preliminary and small, this experience confirmed the results from previous series using a hand-sewn intracorporeal anastomosis. Larger series are required to draw firm conclusions concerning the possible indications for TRRC. Copyright © 2011 John Wiley & Sons, Ltd.

Demographics and Outcomes of Severe Herpes Simplex Virus Hepatitis: a Registry-based Study

Journal of Hepatology. Dec, 2011  |  Pubmed ID: 21703210

Herpes simplex virus hepatitis is a rare, but severe disease, thus far only documented by case reports and short series. The present study was based on the SRTR registry, and included all listed patients for liver transplantation from 1985 to 2009 with a diagnosis of HSV hepatitis.

Immunosuppressive Effects of Streptozotocin-induced Diabetes Result in Absolute Lymphopenia and a Relative Increase of T Regulatory Cells

Diabetes. Sep, 2011  |  Pubmed ID: 21752956

Streptozotocin (STZ) is the most widely used diabetogenic agent in animal models of islet transplantation. However, the immunomodifying effects of STZ and the ensuing hyperglycemia on lymphocyte subsets, particularly on T regulatory cells (Tregs), remain poorly understood.

Complications of Elective Liver Resections in a Center with Low Mortality: a Simple Score to Predict Morbidity

Archives of Surgery (Chicago, Ill. : 1960). Nov, 2011  |  Pubmed ID: 21768406

To develop a score predicting the morbidity of liver resections in a center with low mortality.

Squamous Cell Carcinoma of the Anus-an Opportunistic Cancer in HIV-positive Male Homosexuals

World Journal of Gastroenterology : WJG. Jul, 2011  |  Pubmed ID: 21799644

Squamous cell carcinoma of the anus (SCCA) is a common cancer in the human immunodeficiency virus (HIV)-infected population, and its incidence continues to increase in male homosexuals. Combined chemoradiation with mitomycin C and 5-fluorouracil was poorly tolerated by severely immunocompromised patients in the early 1990s. In the era of highly active antiretroviral therapy (HAART), however, recent data indicate that: (1) most HIV patients with anal cancer can tolerate standard chemotherapy regimens; and (2) this approach is associated with survival rates similar to those of HIV-negative patients. However, HIV-positive patients with SCCA are much younger, more likely to develop local tumor recurrence, and ultimately die from anal cancer than immune competent patients. Taken together, these findings suggest that anal cancer is an often fatal neoplasia in middle-aged HIV-positive male homosexuals. In this population, SCCA is an opportunistic disease resulting in patients with suboptimal immune function from persistent infection and prolonged exposition to oncogenic human papillomaviruses (HPVs). Large-scale cancer-prevention strategies (routine anuscopy and anal papanicolaou testing) should be implemented in this population. In addition, definitive eradication of oncogenic HPVs within the anogenital mucosa of high-risk individuals might require a proactive approach with repeated vaccination.

Survival Predictors for Second-line Chemotherapy in Caucasian Patients with Metastatic Gastric Cancer

Swiss Medical Weekly. 2011  |  Pubmed ID: 21870299

There are very limited data suggesting a benefit for second-line chemotherapy in advanced gastric cancer. Therefore, the number of patients who receive further treatment after failure of first-line chemotherapy varies considerably, ranging from 14% to 75%. In the absence of a demonstrated survival benefit of second-line chemotherapy, appropriate selection of patients based on survival predictors is essential. However, no clinico-pathologic parameters are currently widely adopted in clinical practice. We looked exclusively at Caucasian patients with metastatic gastric cancer treated with second-line chemotherapy to see if we could establish prognostic factors for survival.

Mycotic Aneurysm of the Superior Mesenteric Artery

Surgery. Aug, 2011  |  Pubmed ID: 21875737

Impact of the Number of Infusions on 2-year Results of Islet-after-kidney Transplantation in the GRAGIL Network

Transplantation. Nov, 2011  |  Pubmed ID: 21926944

Insulin independence after islet transplantation is generally achieved after multiple infusions. However, single infusion would increase the number of recipients. Our aim was to evaluate the results of islet-after-kidney transplantation according to the number of infusions.

Robotic Single-port Cholecystectomy Using a New Platform: Initial Clinical Experience

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract. Dec, 2011  |  Pubmed ID: 21948180

The technique of single-port laparoscopy was developed over the past years in an attempt to reduce the invasiveness of surgery. A reduction of incisions and their overall size might result in enhanced postoperative cosmesis and potentially reduce pain when compared to conventional techniques. While manual single-port laparoscopy is technically challenging, a newly approved robotic platform used with the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA, USA) might overcome some of the difficulties of this technique.

Interleukin-1 Receptor Antagonist Modulates the Early Phase of Liver Regeneration After Partial Hepatectomy in Mice

PloS One. 2011  |  Pubmed ID: 21980458

Cytokine administration is a potential therapy for acute liver failure by reducing inflammatory responses and favour hepatocyte regeneration. The aim of this study was to evaluate the role of interleukin-1 receptor antagonist (IL-1ra) during liver regeneration and to study the effect of a recombinant human IL-1ra on liver regeneration.

Cadherin Engagement Protects Human β-cells from Apoptosis

Endocrinology. Dec, 2011  |  Pubmed ID: 21990317

The aim of this study was to assess the expression of different types of cadherins in human islets and their role in human β-cell apoptosis. Expression of E-, N-, and P-cadherins was studied by immunofluorescence on pancreas sections and islet cells, and by Western blotting on protein extracts of isolated islets and islet cells. The effects of specific cadherins on cell adhesion and apoptosis were studied using chimeric proteins containing functional E-, N-, or P-cadherin ectodomains fused to Fc fragment of Ig (E-cad/Fc, N-cad/Fc, and P-cad/Fc) and immobilized on glass substrate. β-Cells were identified by immunofluorescence for insulin and apoptotic cells by terminal deoxynucleotide transferase-mediated 2'-deoxyuridine, 5'-triphosphate nick-end labeling. By immunofluorescence, we showed that E- and N-, and not P-, cadherins were expressed at the surface of islet cells. By triple staining, we showed that E-cadherin was expressed at similar extent in β- and α-cells, whereas N-cadherin was preferentially expressed in β-cells. These results were confirmed by Western blot analysis using protein extracts from fluorescence-activated cell sorting-sorted β- and non-β-cells. Adhesion tests showed that the affinity of islet cells for E-cad/Fc and N-cad/Fc and not for P-cad/Fc was increased compared with control. By terminal deoxynucleotide transferase-mediated 2'-deoxyuridine, 5'-triphosphate nick-end labeling, we showed that the percentage of apoptotic cells was lower in aggregated β-cells compared with single β-cells and that attachment to E-cad/Fc and N-cad/Fc and not to P-cad/Fc decreased apoptosis of single β-cells compared with control. Our results show that at least E- and N-cadherins are expressed at the surface of human β-cells and that these adhesion molecules are involved in the maintenance of β-cell viability.

Learning Curve for Robot-assisted Roux-en-Y Gastric Bypass

Surgical Endoscopy. Apr, 2012  |  Pubmed ID: 22044973

Robot-assisted Roux-en-Y gastric bypass (RYGBP) is rapidly evolving as an important surgical approach in the bariatric field. However, the specific learning curve associated with this new approach remains poorly investigated. This study aimed to evaluate the learning curve for robot-assisted RYGBP.

A Score Predicting Survival After Liver Retransplantation for Hepatitis C Virus Cirrhosis

Transplantation. Apr, 2012  |  Pubmed ID: 22267157

Approximately one fourth of patients transplanted for hepatitis C virus (HCV)-induced liver failure progress to cirrhosis within 5 years, potentially requiring retransplantation. Although the relisting decision can be difficult in these patients, a score could help in selection of candidates with the best potential outcomes.

A Model for Dropout Assessment of Candidates with or Without Hepatocellular Carcinoma on a Common Liver Transplant Waiting List

Hepatology (Baltimore, Md.). Jan, 2012  |  Pubmed ID: 22271250

In many countries, the allocation of liver grafts is based on the Model of End-stage Liver Disease (MELD) score and the use of exception points for patients with hepatocellular carcinoma (HCC). With this strategy, HCC patients have easier access to transplantation than non-HCC ones. In addition, this system does not allow for a dynamic assessment, which would be required to picture the current use of local tumor treatment. This study was based on the Scientific Registry of Transplant Recipients and included 5,498 adult candidates of a liver transplantation for HCC and 43,528 for non-HCC diagnoses. A proportional hazard competitive risk model was used. The risk of dropout of HCC patients was independently predicted by MELD score, HCC size, HCC number, and alpha-fetoprotein. When combined in a model with age and diagnosis, these factors allowed for the extrapolation of the risk of dropout. Because this model and MELD did not share compatible scales, a correlation between both models was computed according to the predicted risk of dropout, and drop-out equivalent MELD (deMELD) points were calculated. CONCLUSION: The proposed model, with the allocation of deMELD, has the potential to allow for a dynamic and combined comparison of opportunities to receive a graft for HCC and non-HCC patients on a common waiting list.

Comparative Impact on Islet Isolation and Transplant Outcome of the Preservation Solutions Institut Georges Lopez-1, University of Wisconsin, and Celsior

Transplantation. Apr, 2012  |  Pubmed ID: 22343333

Institut Georges Lopez-1 (IGL-1) is a preservation solution similar to University of Wisconsin (UW) with reversed Na/K contents. In this study, we assessed the impact of IGL-1, UW, and Celsior (CS) solutions on islet isolation and transplant outcome.

Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass

Obesity Surgery. Jan, 2012  |  Pubmed ID: 21538177

Robotic surgery is a complex technology offering technical advantages over conventional methods. Still, clinical outcomes and financial issues have been subjects of debate. Several studies have demonstrated higher costs for robotic surgery when compared to laparoscopy or open surgery. However, other studies showed fewer costly anastomotic complications after robotic Roux-en-Y gastric bypass (RYGBP) when compared to laparoscopy.

Value of Performing Routine Postoperative Liquid Contrast Swallow Studies Following Robot-assisted Roux-en-Y Gastric Bypass

Swiss Medical Weekly. 2012  |  Pubmed ID: 22481375

In most centers, Upper Gastrointestinal series (UGI) following Roux-en-Y Gastric Bypass (RYGB) is performed to rule out GJ anastomotic leak. According to the introduction of robotic technology associated with a hypothetical decrease of anastomotic complications, we aim to assess the validity and cost effectiveness of early routine UGI following robot-assisted RYGB.

Association Between Lymphoepithelial Cysts of the Pancreas and HIV Infection

Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]. Jan, 2012  |  Pubmed ID: 22487477

To report the association of lymphoepithelial cysts (LEC) of the pancreas with Human Immunodeficiency Virus (HIV) infection. An association between LEC and HIV infection is already established in the parotid gland (PG).

Console-integrated Stereoscopic OsiriX 3D Volume-rendered Images for Da Vinci Colorectal Robotic Surgery

Surgical Innovation. May, 2012  |  Pubmed ID: 22549904

The increased distance between surgeon and surgical field is a significant problem in laparoscopic surgery. Robotic surgery, although providing advantages for the operator, increases this gap by completely removing force feedback. Enhancement with visual tools can therefore be beneficial. The goal of this preliminary work was to create a custom plugin for OsiriX to display volume-rendered images in the da Vinci surgeon's console. The TilePro multi-input display made the generated stereoscopic pairs appear to have depth. Tumor position, vascular supply, spatial location, and relationship between organs appear directly within the surgeon's field of view. This study presents a case of totally robotic right colectomy for cancer using this new technology. Sight diversion was no longer necessary. Depth perception was subjectively perceived as profitable. Total immersion in the operative field helped compensate for the lack of tactile feedback specific to robotic intervention. This innovative tool is a step forward toward augmented-reality robot-assisted surgery.

Detection of ATP by "in Line" 31P Magnetic Resonance Spectroscopy During Oxygenated Hypothermic Pulsatile Perfusion of Pigs' Kidneys

Magma (New York, N.Y.). May, 2012  |  Pubmed ID: 22644411

To demonstrate that adenosine triphosphate (ATP), which provides a valuable biomarker for kidney viability in the context of donation after cardiac death (DCD) transplantation, can be detected by means of (31)P magnetic resonance spectroscopy (MRS) if kidneys are perfused with oxygenated hypothermic pulsatile perfusion (O(2)+HPP).

Intra-operative Fluorescent Cholangiography Using Indocyanin Green During Robotic Single Site Cholecystectomy

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. May, 2012  |  Pubmed ID: 22648637

Very recently, robotic single site cholecystectomy (RSSC) has been reported feasible and safe for selected cases. While an intra-operative cholangiography can be performed, data is scarce with respect to its use. Indocyanin green (ICG) has been shown to be a viable option to visualize biliary anatomy. Since the introduction of a new near infrared camera integrated to the da Vinci Si System (Intuitive Surgical, Sunnyvale, CA), the surgeon is able to assess the biliary anatomy by a non-invasive and non-ionizing method. This paper presents the first report of ICG imaging during a RSSC.

Factors Predicting Survival After Post-transplant Hepatocellular Carcinoma Recurrence

Journal of Hepato-biliary-pancreatic Sciences. Jun, 2012  |  Pubmed ID: 22710887

Although factors associated with an increased risk of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been extensively studied, the history of patients with a post-transplant recurrence is poorly known.

Robotic Laparoendoscopy Single Site Surgery: a Transdisciplinary Review

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Jun, 2012  |  Pubmed ID: 22711444

Recent developments in minimal invasive surgery have led to laparoendoscopic single site surgery (LESS). This new approach has great potential but remains technically challenging. In order to relieve these difficulties many authors have adapted robotic technology to single site surgery. Numerous approaches have been developed and there is no real consensus.

Robotic Single-incision Laparoscopic Cholecystectomy

Journal of Robotic Surgery. Sep, 2012  |  Pubmed ID: 22956983

Posttransplant Cellular Immune Reactivity Against Donor Antigen Correlates with Clinical Islet Transplantation Outcome: Towards a Better Posttransplant Monitoring

Cell Transplantation. 2012  |  Pubmed ID: 22963841

The aim of the present study was to assess the efficiency of cell-based immune assays in the detection of alloreactivity after islet transplantation and to correlate these results with clinical outcome. Mixed lymphocyte cultures were performed with peripheral blood mononuclear cells from recipients (n = 14), donors, or third party. The immune reactivity was assessed by the release of IFN-γ (ELISpot), cell proliferation (FACS analysis for Ki67), and cytokine quantification (Bioplex). Islet function correlated with the number of IFN-γ-secreting cells following incubation with donor cells (p = 0.007, r = -0.50), but not with third party cells (p = 0.61). Similarly, a high number of donor-specific proliferating cells was associated with a low islet function (p = 0.006, r = -0.51). Proliferating cells were mainly CD3(+)CD4(+) lymphocytes and CD3(-)CD56(+) natural killer cells (with low levels of CD3(+)CD8(+) lymphocytes). Patients with low islet function had increased levels of CD4(+)Ki67(+)cells (p ≤ 0.0001), while no difference was observed in CD8(+)Ki67(+) and CD56(+)Ki67(+) cells. IFN-γ, IL-5, and IL-17 levels were increased in patients with low islet function, but IL-10 levels tended to be lower. IFN-γ-ELISpot, proliferation, and cytokines were similarly accurate in predicting clinical outcome (AUC = 0.77 ± 0.088, 0.85 ± 0.084, and 0.88 ± 0.074, respectively). Cellular immune reactivity against donor cells correlates with posttransplant islet function. The tested assays have the potential to be of substantial help in the management of islet graft recipients and deserve prospective validation.

Transarterial Embolization in Acute Colonic Bleeding: Review of 11 Years of Experience and Long-term Results

International Journal of Colorectal Disease. Dec, 2012  |  Pubmed ID: 23208010

BACKGROUND: Lower gastrointestinal bleeding represents 20 % of all gastrointestinal bleedings. Interventional radiology has transformed the treatment of this pathology, but the long-term outcome after selective embolization has been poorly evaluated. The aim of this study is thus to evaluate the short-term and long-term outcomes after selective embolization for colonic bleeding. METHODS: From November 1998 to December 2010, all acute colonic embolizations for hemorrhage were retrospectively reviewed and analyzed. The risk factors for post-embolization ischemia were also assessed. RESULTS: Twenty-four patients underwent colonic embolization. There were 6 men and 18 women with a median age of 80 years (range, 42-94 years). The underlying etiologies included diverticular disease (41.9 %), post-polypectomy bleeding (16.7 %), malignancy (8.2 %), hemorrhoid (4.1 %), and angiodysplasia (4.1 %). In 23 patients, bleeding stopped (95.8 %) after selective embolization. One patient presented a recurrence of bleeding with hemorrhagic shock and required urgent hemorrhoidal ligature. Four patients required an emergent surgical procedure because of an ischemic event (16.7 %). One patient died of ileal ischemia (mortality, 4.1 %). The level of embolization and the length of hypoperfused colon after embolization were the only risk factors for emergent operation. Mean hospital stay was 18 days (range, 9-44 days). After a mean follow-up of 28.6 months (range, 4-108 months), no other ischemic events occurred. CONCLUSION: In our series, selective transarterial embolization for acute colonic bleeding was clinically effective with a 21 % risk of bowel ischemia. The level of embolization and the length of the hypoperfused colon after embolization should be taken into consideration for emergent operation.

Augmented Reality to the Rescue of the Minimally Invasive Surgeon. The Usefulness of the Interposition of Stereoscopic Images in the Da Vinci™ Robotic Console

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Dec, 2012  |  Pubmed ID: 23239589

BACKGROUND: Computerized management of medical information and 3D imaging has become the norm in everyday medical practice. Surgeons exploit these emerging technologies and bring information previously confined to the radiology rooms into the operating theatre. The paper reports the authors' experience with integrated stereoscopic 3D-rendered images in the da Vinci surgeon console. METHODS: Volume-rendered images were obtained from a standard computed tomography dataset using the OsiriX DICOM workstation. A custom OsiriX plugin was created that permitted the 3D-rendered images to be displayed in the da Vinci surgeon console and to appear stereoscopic. These rendered images were displayed in the robotic console using the TilePro multi-input display. The upper part of the screen shows the real endoscopic surgical field and the bottom shows the stereoscopic 3D-rendered images. These are controlled by a 3D joystick installed on the console, and are updated in real time. RESULTS: Five patients underwent a robotic augmented reality-enhanced procedure. The surgeon was able to switch between the classical endoscopic view and a combined virtual view during the procedure. Subjectively, the addition of the rendered images was considered to be an undeniable help during the dissection phase. CONCLUSION: With the rapid evolution of robotics, computer-aided surgery is receiving increasing interest. This paper details the authors' experience with 3D-rendered images projected inside the surgical console. The use of this intra-operative mixed reality technology is considered very useful by the surgeon. It has been shown that the usefulness of this technique is a step toward computer-aided surgery that will progress very quickly over the next few years. Copyright © 2012 John Wiley & Sons, Ltd.

Impact of Robotic General Surgery Course on Participants' Surgical Practice

Surgical Endoscopy. Jan, 2013  |  Pubmed ID: 23292560

BACKGROUND: Courses, including lectures, live surgery, and hands-on session, are part of the recommended curriculum for robotic surgery. However, for general surgery, this approach is poorly reported. The study purpose was to evaluate the impact of robotic general surgery course on the practice of participants. METHODS: Between 2007 and 2011, 101 participants attended the Geneva International Robotic Surgery Course, held at the University Hospital of Geneva, Switzerland. This 2-day course included theory lectures, dry lab, live surgery, and hands-on session on cadavers. After a mean of 30.1 months (range, 2-48), a retrospective review of the participants' surgical practice was performed using online research and surveys. RESULTS: Among the 101 participants, there was a majority of general (58.4 %) and colorectal surgeons (10.9 %). Other specialties included urologists (7.9 %), gynecologists (6.9 %), pediatric surgeons (2 %), surgical oncologists (1 %), engineers (6.9 %), and others (5.9 %). Data were fully recorded in 99 % of cases; 46 % of participants started to perform robotic procedures after the course, whereas only 6.9 % were already familiar with the system before the course. In addition, 53 % of the attendees worked at an institution where a robotic system was already available. All (100 %) of participants who started a robotic program after the course had an available robotic system at their institution. CONCLUSIONS: A course that includes lectures, live surgery, and hands-on session with cadavers is an effective educational method for spreading robotic skills. However, this is especially true for participants whose institution already has a robotic system available.

Docking of the Da Vinci Si Surgical System® with Single-site Technology

The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS. Mar, 2013  |  Pubmed ID: 23348914

Strategies to spare operating room (OR) times are crucial to limiting the costs involved in robotic surgery. Among other factors, the pre-operative set-up and docking phases have been incriminated at first to be time consuming. The docking process on the standard multiport da Vinci Surgical System has not been shown to significantly prolong the overall OR time. This study aims to analyse whether the length of the docking process on the new da Vinci Si Surgical System with Single-Site™ technology remains acceptable.

Systematic Review and Meta-analysis of Fibrin Sealants for Patients Undergoing Pancreatic Resection

HPB : the Official Journal of the International Hepato Pancreato Biliary Association. Mar, 2013  |  Pubmed ID: 23461684

INTRODUCTION: Post-operative pancreatic fistula (POPF) is a common complication after partial pancreatic resection, and is associated with increased rates of sepsis, mortality and costs. The role of fibrin sealants in decreasing the risk of POPF remains debatable. The aim of this study was to evaluate the literature regarding the effectiveness of fibrin sealants in pancreatic surgery. METHODS: A comprehensive database search was conducted. Only randomized controlled trials comparing fibrin sealants with standard care were included. A meta-analysis regarding POPF, intra-abdominal collections, post-operative haemorrhage, pancreatitis and wound infections was performed according to the recommendations of the Cochrane collaboration. RESULTS: Seven studies were included, accounting for 897 patients. Compared with controls, patients receiving fibrin sealants had a pooled odds ratio (OR) of developing a POPF of 0.83 [95% confidence interval (CI): 0.6-1.14], P = 0.245. There was a trend towards a reduction in post-operative haemorrhage (OR = 0.43 (95%CI: 0.18-1.0), P = 0.05) and intra-abdominal collections (OR = 0.52 (95%CI: 0.25-1.06), P = 0.073) in those patients receiving fibrin sealants. No difference was observed in terms of mortality, wound infections, re-interventions or hospital stay. CONCLUSION: On the basis of these results, fibrin sealants cannot be recommended for routine clinical use in the setting of pancreatic resection.

Stereoscopic Augmented Reality for Da Vincii™ Robotic Biliary Surgery

International Journal of Surgery Case Reports. 2013  |  Pubmed ID: 23466685

New laparoscopic techniques put distance between the surgeon and his patient.

Perforated Duodenal Diverticulum, a Rare Complication of a Common Pathology: A Seven-patient Case Series

World Journal of Gastrointestinal Surgery. Mar, 2013  |  Pubmed ID: 23556061

Duodenal diverticula (DD) are frequently encountered and are usually asymptomatic, with an incidence at autopsy of 22%. Perforation of DD is a rare complication (around 160 cases reported) with potentially dramatic consequences. However, little evidence regarding its treatment is available in the literature. The aim of this study was to review our experience of perforated DD, with a focus on surgical management. Between January 2001 and June 2011, all perforated DD were retrospectively reviewed at a single centre. Seven cases (5 women and 2 men; median age: 72.4 years old, rang: 48-91 years) were found. The median American Society of Anesthesiologists' score in this population was 3 (range: 3-4). The perforation was located in the second portion of duodenum (D2) in six patients and in the third portion (D3) in one patient. Six of these patients were treated surgically: five patients underwent DD resection with direct closure and one was treated by surgical drainage and laparostomy. One patient was treated conservatively. One patient died and one patient presented a leak that was successfully treated conservatively. The median hospital stay was 21.1 d (range: 15-30 d). Perforated DD is an uncommon presentation of a common pathology. Diverticular excision with direct closure seems to offer the best chance of survival and was associated with a low morbidity, even in fragile patients.

Ampullectomy for an Unexpected Ampullary Hamartoma in a Heterotaxic Patient

International Journal of Surgery Case Reports. Mar, 2013  |  Pubmed ID: 23608516

INTRODUCTION: Heterotaxy designates rare congenital disorders of organ positioning in the thoracic and abdominal cavities, which can be associated with numerous anomalies, complicating the surgical management because of the loss of conventional anatomic landmarks. PRESENTATION OF CASE: A 72-year-old man was found to have asymptomatic cholestasis. Further workup included computed tomography and magnetic resonance cholangiopancreatography that revealed anomalies of lateralization of digestive organs associated with intestinal malrotation and polysplenia, and a stone-like element in the main bile duct. Endoscopic retrograde cholangiopancreatography failed to extract the lesion. Laparotomy found no stone, but a polypoid tumor with ampullary implantation. Pancreaticoduodenectomy was judged unreasonable due to the presence of macroscopic cirrhosis and a complete ampullectomy was performed. Histopathological examination revealed a hamartomatous polyp. DISCUSSION: The unusual angle of the duodenoscope in a left-sided duodenum may have contributed to the improper pre-operative diagnosis. Endosonography could have recognized the tissular origin of the lesion and prompted a more detailed preoperative planning. It was fortunate that the patient ended up receiving the appropriate treatment despite the absence of an adequate pre-operative diagnosis, as the option of performing an extended resection was ruled out due to the presence of cirrhosis. CONCLUSION: Although heterotaxy leads to increased technical difficulties in performing usual endoscopic and surgical procedures, it can be safely managed by experienced surgeons as illustrated by the present case. Imaging modalities have limited sensitivity in the diagnosis of small ampullary tumors. As false-negatives are likely to occur, this possibility should guide the choice of the best operation.

Learning Tools and Simulation in Robotic Surgery: State of the Art

World Journal of Surgery. May, 2013  |  Pubmed ID: 23640724

Robotic surgery has emerged as a new technology over the last decade and has brought with it new challenges, particularly in terms of teaching and training. To overcome these challenges, robotic courses, virtual simulation, and dual consoles have been successfully introduced. In fact, there are several simulators currently on the market that have proven to be a valid option for training, especially for the novice trainee. Robotic courses have also found success around the world, allowing participants to implement robotic programs at their institution, typically with the help of a proctor. More recently, the dual console has enabled two surgeons to be operating at the same time. Having one experienced surgeon and one trainee each at his or her own console has made it an obvious choice for training. Although these methods have been successfully introduced, the data remain relatively scarce concerning their role in training. The aim of this article was to review the various methods and tools involved in the training of surgeons in robotic surgery.

Robot-assisted Roux-en-Y Gastric Bypass for Super Obese Patients: a Comparative Study

Obesity Surgery. Mar, 2013  |  Pubmed ID: 23188477

Superobese patients (SO) (body mass index (BMI) ≥ 50 kg/m(2)) represent a real surgical challenge and the best management remains debatable. While the safety of a laparoscopic approach has been questioned for this population, robotics has been introduced in the armamentarium of the bariatric surgeon, yet its role remains poorly assessed, especially for a very high BMI. The study aim is thus to report our experience with robot-assisted Roux-en-Y gastric bypass (RYGB) for SO. From July 2006 to May 2012, 288 consecutive robot-assisted RYGB procedures have been performed at a single institution. All data were collected prospectively in a dedicated database. Among those patients, 41 were SO (14.2 %). All the peri- and postoperative parameters were compared to the morbidly obese (MO) group (BMI < 50). Data have been reviewed retrospectively. The SO group presented a higher ASA score and more male patients. The operative time was similar between both groups, yet there were more conversions in the SO group (two versus one for MO; p = 0.05). The morbidity and mortality rates were similar between both groups. The length of stay was longer for the SO population (7 vs. 6 days; p = 0.03). The percent BMI loss was similar at 1 year (34 vs. 34 %; p = 1), but the percent excess BMI loss was higher for the MO group (83 vs. 65 % for the SO group; p = 0.0007). Robot-assisted RYGB can be performed safely for SO, with complication rates and functional results at 1 year comparable to MO, yet this approach for SO has been associated with a slightly increased conversion rate and length of stay.

The Impact of Wait List Body Mass Index Changes on the Outcome After Liver Transplantation

Transplant International : Official Journal of the European Society for Organ Transplantation. Feb, 2013  |  Pubmed ID: 23199077

Obesity is associated with poor health outcomes in the general population, but the evidence surrounding the effect of body mass index (BMI) on postliver transplantation survival is contradictory. The aim of this study was to assess the impact of wait list BMI and BMI changes on the outcomes after liver transplantation. Using the Scientific Registry of Transplant Recipients, we compared survival among different BMI categories and examined the impact of wait list BMI changes on post-transplantation mortality for patients undergoing liver transplantation. Cox proportional hazards multivariate regression was carried out to adjust for confounding factors. Among 38 194 recipients, underweight patients had a poorer survival compared with normal weight (HR = 1.3, 95% CI: 1.13-1.49). Conversely, overweight and mildly obese men experienced better survival rates compared with their lean counterparts (HR = 0.9, 95% CI: 0.84-0.96, and HR = 0.86, 95% CI: 0.79-0.93 respectively). Female patients gaining weight over 18.5 kg/m(2) while on the wait list showed improving outcomes (HR = 0.46, (95% CI: 0.28-0.76)) compared with those remaining underweight. This study supports the harmful impact of underweight on postliver transplant survival, and highlights the need for a specific monitoring and management of candidates with BMIs close to 18.5 kg/m(2) . Obesity does not constitute an absolute contraindication to liver transplantation.

Three-dimensional Laparoscopy: a Step Toward Advanced Surgical Navigation

Surgical Endoscopy. Feb, 2013  |  Pubmed ID: 22806536