Etude prospective et comparative du traitement de la maladie hémorroïdaire par anopexie (Longo) ou par ligature des artères hémorroïdaires sous contrôle doppler avec mucopexie (THD)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Voie d'abord dans la colectomie gauche.Intérêt d'une incision abdominale transverse

Introduction :La laparoscopie (L) semble diminuer la morbidité péri opératoire dans les colectomies gauches par rapport à une incision médiane (M).L'intérêt d'une voie d'abord (T) est inconnu dans dans cette indication.Nous présentons ici, une étude comparative rétrospective à long terme entre ces trois voies d'abord.Résultats : L'étude concernait 3 groupes de 53 patients appariés.L'indication était bénigne dans 48,4% et un cancer dans 51,6% des cas.Le suivi médian était de 7,9 années (2,8-9,5).La morbidité était de 39,6% et plus élevée dans les groupes T et M : 52% et 45% vs 21% (p=0,002).Elle était liée aux complications extra digestives avec 36%, 34% et 13,2% (p=0,02) et, en particulier, respiratoires avec 15%, 21% et 2% (p=0,01).La survenue d'abcès de paroi semblait par ailleurs supérieure dans le groupe T : 15% vs. 6% et 6% - p=0,057.Le reste de la morbidité chirurgicale, principalement représentée par les fistules anastomotiques (n=15, 9,4%) était comparable.La durée de séjour était plus faible pour la L (méd. : 10,9, 6 jours-p<0,0001).Un taux élevé de marges <5cm était relevé avec 23%, 16% et 30% des cas - p=0,44.L'étude au long cours constatait 23 éventrations, respectivement 8%, 23% et 3%(p=0,004).En analyse multivariée, l'incision T était supérieure à une M : OR= 4,47 - IC95%[1,2-16].10 cas d'occlusion sur bride était authentifiés (6,3%).L'analyse statistique ne retrouvait pas de facteur de risque.Conclusion : la voie d'abord laparoscopique diminue la morbidité péri opératoire.L'incision transverse est plus solide et moins à risque d'éventration qu'une médiane.La voie d'abord ne semble pas influer la survenue d'occlusons sur brideMONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Technique of intragastric laparoscopic resection for gastrointestinal stromal tumor (with video)

International audienc

Prise en charge et surveillance du cancer colo-rectal (analyses médico-économiques et décisionnelles)

Le cancer colo-rectal est le cancer le plus fréquent en France tous sexes confondus avec 33 000 nouveaux cas par an. Pour rendre compte de la pratique et de l'efficacité du système de santé, une évaluation de la prise en charge, de la survie et du suivi du cancer colorectal a été réalisée dans le département de l'Hérault. Patients et méthodes : Trois cent quarante quatre et 256 cas-incidents de cancer colorectal ont respectivement été recensés sur l'année 1992 dans le département de l'Hérault et eu une résection à visée curative d'un cancer colorectal. La diversité des choix thérapeutiques, la survie, les modalités et le coût des examens de la surveillance ont été évalués à 5 ans. Une simulation du suivi de ces patients a été réalisée à 5 et 7 ans par un modèle de Markov. Les ratios coût-efficacité de deux stratégies de surveillance ont été comparés. Résultat : Dans le département de l'Hérault, un standard de prise en charge comme la chimiothérapie adjuvante du cancer colorectal avec envahissement ganglionnaire n'était pas respecté dans plus de la moitié des cas traités. Les patients habitants en zone semi urbaine ou pris en charge dans des structures hospitalières non spécialisées avaient un plus mauvais pronostic. Lors du suivi d'un patient opéré à visée curative, les cliniciens ont pratiqué dans 70% des cas une surveillance allégée et dans 30% des cas une surveillance renforcée par rapport aux recommandations sans qu'il existe de différence significative de survie entre les deux groupes. La simulation par le modèle de Markov montrait que la surveillance standard avec dosage de l'ACE semblait plus coût-efficace pour les patients de moins de 75 ans ayant eu une tumeur de stade C de Dukes. Conclusion : Une politique de Santé adéquate et efficace est nécessaire pour diminuer les insuffisances et les inégalités existant dans le département de l'Hérault. L'intensité du suivi d'un patient opéré à visée curative d'un cancer colorectal doit tenir compte essentiellement du stade histopathologique initiale et de l'âge.LYON1-BU.Sciences (692662101) / SudocSudocFranceF

Results of the FUSE Evaluation Project in France

International audienceBackgroundThe Federation of Visceral and Digestive Surgery (FCVD) is in charge in France of the continuing medical education of digestive surgeons. Since 2016 and in collaboration with SAGES, it has offered the Fundamental Use of Surgical Energy (FUSE) program as part of the continuing education for surgeons including eLearning and hands-on workshops.MethodsThe aim of this study was to evaluate the impact of the FUSE program on the participants by participating in a knowledge test and completing a survey.Results485 participants fully completed the knowledge test of 18 questions. Post-test assessment showed an increase in the mean score with respect to pre-test assessment, and the surgeons who have participated to the hands-on workshops had a better score. 304 participants filled the survey of 6 questions. The majority were satisfied by the FUSE program and felt that the objectives were achieved.ConclusionsThe FUSE program developed by SAGES and adopted by the FCVD in France was very much appreciated by the participants and achieved its educational objectives. Our goal is to spread it as widely as possible to all members of the operating room team

Similarities and differences of interstitial lung disease associated with pathogenic variants in SFTPC and ABCA3 in adults

International audienceAbstract Background and Objective Variants in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults, with few studies in adults. Methods We conducted a multicentre retrospective study of all consecutive adult patients diagnosed with ILD associated with variants in SFTPC or ABCA3 in the French rare pulmonary diseases network, OrphaLung. Variants and chest computed tomography (CT) features were centrally reviewed. Results We included 36 patients (median age: 34 years, 20 males), 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between groups. Baseline median FVC was 59% ([52–72]) and DLco was 44% ([35–50]). An unclassifiable pattern of fibrosing ILD was the most frequent on chest CT, found in 85% of patients, however with a distinct phenotype with ground‐glass opacities and/or cysts. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Annually, FVC and DL CO declined by 1.87% and 2.43% in the SFTPC group, respectively, and by 0.72% and 0.95% in the ABCA3 group, respectively (FVC, p = 0.014 and DL CO , p = 0.004 for comparison between groups). Median time to death or lung transplantation was 10 years in the SFTPC group and was not reached at the end of follow‐up in the ABCA3 group. Conclusion SFTPC and ABCA3 ‐associated ILD present with a distinct phenotype and prognosis. A radiologic pattern of fibrosing ILD with ground‐glass opacities and/or cysts is frequently found in these rare conditions

Interstitial lung diseases associated with mutations of poly(A)-specific ribonuclease: A multicentre retrospective study

Background and objective: Poly(A)-specific ribonuclease (PARN) mutations have been associated with familial pulmonary fibrosis. This study aims to describe the phenotype of patients with interstitial lung disease (ILD) and heterozygous PARN mutations. Methods: We performed a retrospective, observational, non-interventional study of patients with an ILD diagnosis and a pathogenic heterozygous PARN mutation followed up in a centre of the OrphaLung network. Results: We included 31 patients (29 from 16 kindreds and two sporadic patients). The median age at ILD diagnosis was 59 years (range 54 to 63). In total, 23 (74%) patients had a smoking history and/or fibrogenic exposure. The pulmonary phenotypes were heterogenous, but the most frequent diagnosis was idiopathic pulmonary fibrosis (n = 12, 39%). Haematological abnormalities were identified in three patients and liver disease in two. In total, 21 patients received a specific treatment for ILD: steroids (n = 13), antifibrotic agents (n = 11), immunosuppressants (n = 5) and N-acetyl cysteine (n = 2). The median forced vital capacity decline for the whole sample was 256 ml/year (range −363 to −148). After a median follow-up of 32 months (range 18 to 66), 10 patients had died and six had undergone lung transplantation. The median transplantation-free survival was 54 months (95% CI 29 to ∞). Extra-pulmonary features were less frequent with PARN mutation than telomerase reverse transcriptase (TERT) or telomerase RNA component (TERC) mutation. Conclusion: IPF is common among individuals with PARN mutation, but other ILD subtypes may be observed.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult