A Pitfall in the Diagnosis of Unresectable Liver Metastases: Multiple Bile Duct Hamartomas (von Meyenburg Complexes)

Von Meyenburg complexes (VMC) are a cluster of benign liver malformations including biliary cystic lesions, with congenital fibrocollagenous stroma. This rare entity can mimick multiple secondary hepatic lesions. We report a case of a 56-year-old woman who had multiples liver lesions 12 years after operation for breast cancer. Biopsy of the hepatic lesion confirmed the diagnosis of VMC. Preoperative discovery of multiple gray-white nodular lesions scattered on the surface of the liver should not always contraindicate curative liver resection. The diagnosis of VMC should be known and confirmed with liver biopsy

Performance evaluation of reverse osmosis (RO) pre-treatment technologies for in-land brackish water treatment

Integration of renewable energy with desalination technologies has emerged as an attractive solution to augment fresh water supply sustainably. Fouling and scaling are still considered as limiting factors in membrane desalination processes. For brackish water treatment, pre-treatment of reverse osmosis (RO) feed water is a key step in designing RO plants avoiding membrane fouling. This study aims to compare at pilot scale the rejection efficiency of RO membranes with multiple pre-treatment options at different water recoveries (30, 35, 40, 45 and 50%) and TDS concentrations (3500, 4000, and 4500mg/L). Synthetic brackish water was prepared and performance evaluation were carried out using brackish water reverse osmosis (BWRO) membranes (Filmtec LC-LE-4040 and Hydranautics CPA5-LD-4040) preceded by 5 and 1μm cartridge filters, 0.02μm ultra-filtration (UF) membrane, and forward osmosis (FO) membrane using 0.25M NaCl and MgCl2 as draw solutions (DS). It was revealed that FO membrane with 0.25M MgCl2 used as a draw solution (DS) and Ultra-filtration (UF) membrane followed by Filmtec membrane gave overall 98% rejection but UF facing high fouling potential due to high applied pressure. Use of 5 and 1μm cartridge filter prior to Filmtec membrane also showed effective results with 95% salt rejection

Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden

<p/> <p>Background</p> <p>Acute surgery in the management of malignant colonic obstruction is associated with high morbidity and mortality. The use of self-expanding metal stents (SEMS) is an alternative method of decompressing colonic obstruction. SEMS may allow time to optimize the patient and to perform preoperative staging, converting acute surgery into elective. SEMS is also proposed as palliative treatment in patients with contraindications to open surgery. Aim: To review our experience of SEMS focusing on clinical outcome and complications. The method used was a review of 75 consecutive trials at SEMS on 71 patients based on stent-protocols and patient charts.</p> <p>Findings</p> <p>SEMS was used for palliation in 64 (85%) cases and as a bridge to surgery in 11 (15%) cases. The majority of obstructions, 53 (71%) cases, were located in the recto-sigmoid. Technical success was achieved in 65 (87%) cases and clinical decompression was achieved in 60 (80%) cases. Reasons for technical failure were inability to cannulate the stricture in 5 (7%) cases and suboptimal SEMS placement in 3 (4%) cases. Complications included 4 (5%) procedure-related bowel perforations of which 2 (3%) patients died in junction to post operative complications. Three cases of bleeding after SEMS occurred, none of which needed invasive treatment. Five of the SEMS occluded. Two cases of stent erosion were diagnosed at the time of surgery. Average survival after palliative SEMS treatment was 6 months.</p> <p>Conclusion</p> <p>Our results correspond well to previously published data and we conclude that SEMS is a relatively safe and effective method of treating malignant colonic obstruction although the risk of SEMS-related perforations has to be taken into account.</p

Functional outcomes in symptomatic versus asymptomatic patients undergoing incisional hernia repair: Replacing one problem with another? A prospective cohort study in 1312 patients

Background: Incisional hernias can be associated with pain or discomfort. Surgical repair especially mesh reinforcement, may likewise induce pain. The primary objective was to assess the incidence of pain after hernia repair in patients with and without pre-operative pain or discomfort. The secondary objectives were to determine the preferred mesh type, mesh location and surgical technique in minimizing postoperative pain or discomfort. Materials and methods: A registry-based prospective cohort study was performed, including patients undergoing incisional hernia repair between September 2011 and May 2019. Patients with a minimum follow-up of 3–6 months were included. The incidence of hernia related pain and discomfort was recorded perioperatively. Results: A total of 1312 patients were included. Pre-operatively, 1091 (83%) patients reported pain or discomfort. After hernia repair, 961 (73%) patients did not report pain or discomfort (mean follow-up = 11.1 months). Of the pre-operative asymptomatic patients (n = 221), 44 (20%, moderate or severe pain: n = 14, 32%) reported pain or discomfort after mean follow-up of 10.5 months. Of those patients initially reporting pain or discomfort (n = 1091), 307 (28%, moderate or severe pain: n = 80, 26%) still reported pain or discomfort after a mean follow-up of 11.3 months postoperatively. Conclusion: In symptomatic incisional hernia patients, hernia related complaints may be resolved in the majority of cases undergoing surgical repair. In asymptomatic incisional hernia patients, pain or discomfort may be induced in a considerable number of patients due to surgical repair and one should be aware if this postoperative complication

PIERRE ROY (1880-1950) ET LES MARGES DU SURREALISME SUIVI DU CATALOGUE RAISONNE DE L'OEUVRE

PARIS1-BU Pierre Mendès-France (751132102) / SudocPARIS-INHA (751025206) / SudocSudocFranceF

Prise en charge des péritonites sus-mésocoliques par drainage de Lévy (drain Hélisonde®) (étude rétrospective à propose de 22 cas)

Introduction. Les péritonites postopératoires sus-mésocoliques ont une mortalité de l ordre de 50%. La mise en place d un module d intubation par drain de Levy (DDL) ou Hélisonde® (Hôpital Saint Antoine) a montré des résultats intéressants dans cette indication. L objectif du travail était de présenter notre expérience dans la gestion du drain de Lévy et d analyser rétrospectivement les résultats de ce type de drainage. Matériels et méthodes. Entre 2005 et 2010, 537 patients ont été pris en charge au CHU d Amiens pour péritonite dont 190 pour une péritonite sus-mésocolique. Parmi eux, 22 patients ayant une fistule gastrique ou duodénale ont été pris en charge par intubation trans-orificielle par un DDL. La technique opératoire comportait : un vissage du drain dans l'orifice fistuleux vers la papille, 2 modules de lames au contact du drain et une jéjunostomie d'alimentation. Le DDL était mis en aspiration murale et l'irrigation (sérum physiologique) est débutée par 2000ml de par jour. Les débits extra et intra-luminal étaient quantifiés quotidiennement. Lorsque les sécrétions étaient drainées par le DDL et après ablation des lames, il était dévissé progressivement.. Il y avait 12 hommes et 10 femmes avec un âge moyen de 66 ans; Le délai moyen entre l intervention initiale et la mise en place du drain était de 16,12 +- 14 jours.Les indications étaient: fistule sur ulcère duodénal suturé (n=7), diverticule duodénal (n=3), fistule moignon duodénal (n=3), des fistules cholécysto-duodénales (n=2),sur anastomose gastro-jéjunale (n=1), ischémique (n=1), post-sleeve gastrectomy (n=1), post-traumatique (n=1), post pancréatique aiguë nécrosante (n=1), , plaie de l'angle duodéno-jéjunal (n=1) et une entérectomie totale (n=1). Résultats. Le score APACHE II moyen était de 20 (10-28). Le score de Mannheim moyen était de 28 (ext: 19-34). L ablation du DDL était réalisée en moyenne 35,5 +- 11 jours après sa mise en place. Six patients (27%) sont décédés d un sepsis persistant : pneumopathie (n=2), abcès profond (n=2), défaillance multi-viscérale avec choc septique (n=1),hemoptysie sur aspergillose(n=1). Les complications postopératoires étaient un abcès profond (n=3), une pneumopathie (n=1), une éviscération (n=1). Deux patients ont nécessité une réintervention pour abcès profond persistant (échec du drainage percutané) et pour eviscération. La durée moyenne d hospitalisation était de 70,75 jours. Parmi les 16 patients vivants, 4 ont présenté une fistule chronique : 3 fistules se sont taries après une ou plusieurs séances d encollage du trajet (n=4) et/ou la mise en place d un stent duodénal (n=1). Conclusion. Le drain de Lévy est un des moyens de traitement des péritonites sus-mésocoliques. La mortalité de ces péritonites reste élevée. La gestion du drain de Lévy nécessite une surveillance rapprochée.Introduction: The post-operative sus-mesocolic peritonites have a mortality of the order of 50 %. The implementation of a module of intubation by drain of Lévy ( DL) or Hélisonde ® (Saint Antoine Hospital) showed interesting results in this indication. The objective of the study was to present our experience in the management of the drain of Lévy and to analyze retrospectively the results of this type of drainage. Patients and methods: Between 2005 and 2010, 537 patients were taken care in the university Hospital of Amiens for peritonitis of which 190 for a sus-mesocolic peritonitis . Among them, 22 patients having a gastric or duodenal fistula were taken care by trans-orificial intubation by a DL. The operating technique contained: a screwing of the drain in the fistulous opening towards the papilla, 2 modules of Delbet's drains in the contact of the DL and a jéjunostomy. The DL was put in wall's vacuum and the irrigation (physiological salt solution) is begun by 2000ml by day. The extra and intra-luminal debits were daily quantified. When secretions were drained by the DL and after ablation of Delbet's drains, it was gradually mobilized. There were 12 men and 10 women with an average age of 66 years; the average time between the initial intervention and the implementation of the drain was 16,12 +- 14 days. The indications were: cholecysto-duodenal fistulas ( n=2 ), on gastrojejunal anastomosis ( n=1 ), ischemic ( n=1 ), gastrectomy sleeve ( n=1 ), post-traumatic ( n=1 ), post acute necrotizing pancreatitis ( n=1 ), duodenal diverticule( n=3 ), duodenal stump leakage ( n=3 ), stitched duodenal ulcer ( n=7 ), wound of the duodeno-jéjunal angle ( n=1 ) and a total enterectomy ( n=1 ). Results: The average APACHE II score was 20 ( 10-28 ). The average Mannheim score was 28 (ext: 19-34). The ablation of the DL was realized on average 35,5 +- 11 days after its implementation. Six patients (27 %) died from a persistent sepsis: pneumopathy ( n=2 ), deep abscess ( n=2 ), multi-visceral failure with toxic shock ( n=1 ), hemoptysy on aspergillosis ( n=1 ). The post-operative complications were a deep abscess ( n=3 ), a pneumopathie ( n=1 ), a éviscération ( n=1 ). Two patients required a reintervention for persistent deep abscess (failureof the percutaneous drainage) and for evisceration. The average duration of hospitalization was of 70,75 days. Among 16 alive patients, 4 presented a chronic fistula: 3 fistulas dried up after one or several sessions of glue of the path ( n=4 ) and\or the implementation of a duodenal stent ( n=1 ). Conclusion: The drain of Lévy is one of devices of treatment of the sus-mesocolic peritonites. The mortality of these peritonites remains high. The management of the drain of Lévy requires a close surveillance.AMIENS-BU Santé (800212102) / SudocSudocFranceF

GLUTAMATE ET MSG (LE SYNDROME DU RESTAURANT CHINOIS)

AMIENS-BU Santé (800212102) / SudocSudocFranceF