Should pancreaticoduodenectomy be performed in the elderly?

BACKGROUND/AIMS: Pancreaticoduodenectomy (PD) is indicated in benign or malignant pancreatic head diseases. It is a difficult operation with high morbidity especially in elderly patients. The aim of our study was to determine whether pancreaticoduodenectomy is associated with higher morbidity and mortality in patients ≥ 70 years old. METHODOLOGY: During 17 years, 173 patients were operated by Whipple intervention, whatever the disease. From a prospective database, patients were divided in 2 groups (Group A ≥ 70 years old, Group B <70). RESULTS: Postoperative mortality was not significantly higher in elderly (12% vs. 4.1%; p=0.06). However, re-intervention and morbidity were more important in univariate analysis (p=0.03 and p=0.002 respectively). In multivariate analysis, age ≥ 70 years old was not an independent prognostic factor of mortality (p=0.27) and re-intervention (p=0.07). Whereas age (p=0.04) and preoperative morbidity (p=0.02) were independent prognostic factors of morbidity. CONCLUSIONS: PD requires careful patient selection. However, age should not be a limiting factor

Intraperitoneal mesh repair of small ventral abdominal wall hernias with a Ventralex hernia patch

BACKGROUND: Various surgical procedures have been described in the treatment of small ventral abdominal wall hernias. Mesh repair is becoming popular because of a low recurrence rate. AIM: The aim of this prospective study was to evaluate an open intraperitoneal technique using the Bard Ventralex hernia patch in the treatment of small midline ventral hernias. METHODS: 101 patients were operated on (59 male, 42 female) with a mean age of 54.5 years (range 17-85). Mean operative time was 33 min (range 16-65). The median hospital stay was 2 days (range 1-15). RESULTS: Two patients had a hematoma without wound infection. There were 2 recurrences (2%). Mean postoperative follow-up time was 28.5 months (range 6-55). CONCLUSIONS: Our preliminary results suggest that Ventralex hernia patch repair for ventral hernias can be performed with minimal postoperative morbidity and a low recurrence rate

Frey procedure in patients with chronic pancreatitis: short and long-term outcome from a prospective study

BACKGROUND: The aim of this prospective study was to determine the short- and long-term results of the Frey procedure in the treatment of chronic pancreatitis. METHODS: From September 2000 to November 2009, 44 consecutive patients underwent the Frey procedure. Patients were included in the study before surgery and followed prospectively with assessment of pain relief, weight gain and exocrine/endocrine insufficiency. Twenty-one patients (47.7%) were followed for more than 5 years. RESULTS: This study included 40 men (91 %) and four women (9 %) (mean age: 49 years) with a mean follow-up of 51.5 months. The primary etiology of chronic pancreatitis was chronic alcohol abuse in 38 patients (86.4 %). The major indication for surgery was disabling pain (95.5 %). There was no postoperative mortality. Postoperative morbidity occurred in 15 patients (34.1 %), with specific surgical complications in 11 patients (25 %). The percentage of pain-free patients after surgery was 68.3 %. Eight patients (18.1 %) and seven patients (16 %) developed diabetes de novo and exocrine insufficiency, respectively. The Body Mass Index showed statistically significant improvement during follow-up. Similar beneficial results concerning pain relief and weight gain persisted after the initial 5-year follow-up. CONCLUSIONS: The Frey procedure is an appropriate, safe and effective technique for management of patients with chronic pancreatitis in the absence of neoplasia, based on long-term follow-up

Prognostic Factors of Survival in Repeat Liver Resection for Recurrent Colorectal Metastases: Review of Sixty-Two Cases Treated at a Single Institution

PURPOSE: Liver metastases develop in 50 percent of patients with colorectal carcinoma. Recurrent liver disease is usual. Repeat liver resection remains the only curative treatment. The aim of this study was to review our data on repeat hepatectomy and to analyze potential prognostic factors of survival.METHOD: Patients who underwent repeat liver resection for metastases of colorectal carcinoma between January 1992 and August 2007 were identified from a prospective database and their medical records were analyzed. RESULTS: Of 62 patients who underwent a second hepatectomy, 15 underwent a third hepatectomy, and two underwent a fourth hepatectomy. There was no perioperative mortality. Morbidity was less than 20 percent for the first and second hepatectomies. Overall 5-year survival rate after first hepatectomy was 40 percent. Univariate analysis identified three risk factors confirmed by log-rank test and multivariate Cox regression analysis: serum carcinoembryonic antigen concentrations >5 ng/ml at first hepatectomy (HR = 2.265; CI = 1.140-4.497; P = 0.020), anatomic resection (HR = 2.124; CI = 1.069-4.218; P = 0.031), and tumors ≥3 cm at the second resection (HR = 2.039; CI = 1.013-4.103; P = 0.046). CONCLUSION: Our study shows that repeat hepatectomy for liver metastases of colorectal carcinoma may be performed with low mortality and morbidity. Preoperative concentration of carcinoembryonic antigen at first hepatectomy, tumor size, and type of anatomic resection are independent prognostic factors

Influence de la teneur en oxygène sur la microstructure et le comportement mécanique de la phase « ex bêta » résultant de l'oxydation à haute température (1000-1200°C) du zircaloy 4

International audienceL'étude ici illustrée s'intéresse au comportement thermo - métallurgique - mécanique des alliages de Zr des tubes de gainage du combustible des Réacteurs nucléaires à Eau Pressurisée (REP), lors de transitoires à hautes températures (HT) en ambiance vapeur d'eau, simulant des conditions hypothétiques accidentelles (dites APRP). Il apparaît intéressant d'approfondir la connaissance des phénomènes métallurgiques et thermomécaniques mis en jeu lors de tels transitoires, en particulier vis-à-vis du comportement mécanique résiduel « post oxydation trempe ». Différentes teneurs en oxygène ont été incorporées dans l'alliage étudié, pour simuler la diffusion de cet élément dans le substrat métallique qui intervient lors de l'oxydation HT. Des caractérisations microstructurales par EBSD, MET, MEB... et des caractérisations mécaniques par essai de traction, mesures de constantes physiques... ont permis de décrire la microstructure et le comportement mécanique de la phase résiduelle la plus ductile – phase dite « ex-bêta » - résultant de l'oxydation HT des gaines en zircaloy-4

Design of Dressed Crab Cavities for the HL-LHC Upgrade

The HL-LHC upgrade relies on a set of RF crab cavities for reaching its goals. Two parallel concepts, the Double Quarter Wave (DQW) and the RF Dipole (RFD), are going through a comprehensive design process along with preparation of fabrication in view of extensive tests with beam in SPS. High Order Modes (HOM) couplers are critical in providing damping in RF cavities for operation in accelerators. HOM prototyping and fabrication have recently started at CERN. In this paper, an overview of the final geometry is provided along with an insight in the mechanical and thermal analyses performed to validate the design of this critical component. Emphasis is also given to material selection, prototyping, initial fabrication and test campaigns that are aimed at fulfilling the highly demanding tolerances of the couplers

Alterations in intestinal uptake of putrescine and tissue polyamine concentrations in tumor-bearing rats

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Enhancement of intestinal uptake of dietary putrescine in tumour bearing rats : Adaptation to the polyamine requirement of the tumour

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