Thyroïdectomie chez les patients en surpoids ou obèses : une chirurgie à risque ?

Objectif. Etudier et comparer les complications spécifiques postopératoires de la thyroïdectomie (hypocalcémie, atteinte récurrentielle, hématome post opératoire précoce) de la population ayant un IMC supérieur ou égal à 25 par rapport à la population ayant un IMC inférieur à 25. Matériel et méthode. Une étude prospective a été réalisée au CHU d Angers de septembre 2010 à janvier 2013. Les calcémies postopératoires, la mobilité laryngée, les complications hémorragiques ainsi que les durées d hospitalisation post opératoire et les durées d intervention ont été étudiées et comparées statistiquement par un test de Chi2 ou de Student. Résultats. Au total 240 patients étaient opérés d une thyroïdectomie totale et 126 patients d une isthmolobectomie. 168 patients présentaient un IMC inférieur à 25 et 198 patients présentaient un IMC supérieur ou égal à 25. Il n existait pas de différence statistiquement significative concernant la survenue d une hypoparathyroïdie précoce ou définitive, d une paralysie récurrentielle, d une complication hémorragique ou la durée d hospitalisation en post opératoire. Il existait en revanche une durée opératoire plus importante chez les patients ayant un IMC supérieur ou égal à 25. Conclusion. Malgré une durée opératoire plus importante, la thyroïdectomie (totale ou isthmolobectomie) peut être réalisée en toute sécurité chez les patients ayant un IMC supérieur ou égal à 25.Objective: To study and compare the specific postoperative complications of thyroidectomy in a population with a Body Mass Index (BMI) greater than or equal to 25 to a population with a BMI below 25. Design: A prospective study was performed from September 2010 to January 2013. Methods: Postoperative calcemia, laryngeal mobility, bleeding or infectious complications, postoperative hospital stay and operation time were studied and compared statistically by a Chi2 test or student. Results: 240 patients underwent total thyroidectomy and 126 a partial thyroidectomy. 168 patients had a lower BMI to 25 and 198 patients had a BMI greater than or equal to 25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications or postoperative duration of stay. There was however a significant operative time in patients with a BMI greater than or equal to 25 Conclusion: Despite a larger operating time, thyroidectomy (total or partial) can be performed safely in patients with a BMI greater than or equal to 25.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

Genetic Background of Escherichia coli and Extended-spectrum β-Lactamase Type

ESBL-producing E. coli may arise from interactions between ESBL type, strain genetic background, and selective pressures in various ecologic niches

Expanding the clinical spectrum of hereditary fibrosing poikiloderma with tendon contractures, myopathy and pulmonary fibrosis due to <i>FAM111B </i>mutations

BACKGROUND: Hereditary Fibrosing Poikiloderma (HFP) with tendon contractures, myopathy and pulmonary fibrosis (POIKTMP [MIM 615704]) is a very recently described entity of syndromic inherited poikiloderma. Previously by using whole exome sequencing in five families, we identified the causative gene, FAM111B (NM_198947.3), the function of which is still unknown. Our objective in this study was to better define the specific features of POIKTMP through a larger series of patients. METHODS: Clinical and molecular data of two families and eight independent sporadic cases, including six new cases, were collected. RESULTS: Key features consist of: (i) early-onset poikiloderma, hypotrichosis and hypohidrosis; (ii) multiple contractures, in particular triceps surae muscle contractures; (iii) diffuse progressive muscular weakness; (iv) pulmonary fibrosis in adulthood and (v) other features including exocrine pancreatic insufficiency, liver impairment and growth retardation. Muscle magnetic resonance imaging was informative and showed muscle atrophy and fatty infiltration. Histological examination of skeletal muscle revealed extensive fibroadipose tissue infiltration. Microscopy of the skin showed a scleroderma-like aspect with fibrosis and alterations of the elastic network. FAM111B gene analysis identified five different missense variants (two recurrent mutations were found respectively in three and four independent families). All the mutations were predicted to localize in the trypsin-like cysteine/serine peptidase domain of the protein. We suggest gain-of-function or dominant-negative mutations resulting in FAM111B enzymatic activity changes. CONCLUSIONS: HFP with tendon contractures, myopathy and pulmonary fibrosis, is a multisystemic disorder due to autosomal dominant FAM111B mutations. Future functional studies will help in understanding the specific pathological process of this fibrosing disorder

Antiphospholipides et foie (existe-t'il une atteinte spécifique hépatite en dehors de la macro-thrombose ?)

AIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Occlusion sur bride d'une anse en Y après duodénopancréatectomie céphalique : une cause rare d'angiocholite

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Thyroidectomy in patients with a high BMI: a safe surgery?

International audienceOBJECTIVE: To study and compare the specific postoperative complications of thyroidectomy in a population with a BMI ≥25 with a population having a BMI below 25.DESIGN: A prospective study was carried out from September 2010 to January 2013.METHODS: Postoperative calcemia, laryngeal mobility, bleeding or infectious complications, postoperative hospital stay, and operation time were studied and compared statistically by a χ(2)-test or Student's t-test.RESULTS: A total of 240 patients underwent total thyroidectomy and 126 underwent a partial thyroidectomy. Of them, 168 patients had a BMI below 25 and 198 patients had a BMI ≥25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications, or postoperative duration of hospital stay. There was, however, a significant operative time in patients with a BMI ≥25.CONCLUSION: Despite the longer operative time, thyroidectomy (total or partial) can be performed safely in patients with a BMI ≥25.</p

Management of acute malignant large-bowel obstruction with self-expanding metal stent

International audiencePURPOSE: Colorectal stents are being used for palliation and as a "bridge to surgery" in obstructing colorectal carcinoma. The purpose of this study was to review our experience with self-expanding metal stents (SEMS) as the initial interventional approach in the management of acute malignant large-bowel obstruction.METHODS: Between February 2002 and August 2009, 93 patients underwent the insertion of a SEMS for an obstructing malignant lesion of the left-sided colon or rectum.RESULTS: In 66 patients, the stents were placed for palliation; whereas, in 27 patients they were placed as a bridge to surgery. Stent placement was technically successful in 92.5% (n = 86) of the patients, with a clinical success rate of 86% (n = 80). Three perforations occurred during stent placement, two were treated by an emergency Hartmann operation, and one by a colostomy. In the intention to treat by stent, the peri-interventional mortality was 6.5% (6/93). Stent migration was reported in three cases (3%), and stent obstruction occurred in 11 cases (12%). Of the 24 patients with stents successfully placed as a bridge to surgery, 22 underwent elective single-stage operations with no death or anastomotic complication.CONCLUSION: Stent insertion provided an effective outcome in patients with malignant colonic obstruction as a palliative and preoperative therapy.</p

Addictions comportementales et troubles psychiatriques co-occurrents : étude en population clinique suivie pour addiction comportementale.

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