Total Gastrectomy for locally advanced Cancer: The total Laparoscopic Approach

Total gastrectomy is the treatment of choice for adenocarcinoma of the upper and middle third of the stomach resected with curative intent. The laparoscopic approach allows satisfactory exploration of the peritoneal cavity and optimizes staging in borderline T3 or T4 tumours in patients affected by locally advanced tumours or intraperitoneal carcinomatosis. Laparoscopy can eliminate unnecessary laparotomies in 10 % of patients affected by these conditions with formal contraindications for resection [1] . Complete resection of the stomach associated with D2 lymph node dissection is also performed using a currently well-established technique [2, 3] . The specificity of laparoscopic gastric resection for cancer is that the stomach and the greatomentum are withdrawn separately.Reconstruction of the digestive tract is more complex, and requires a variety of techniques (supra-umbilical mini-laparotomy, Orvil® technique, enlarging a port-site for passage of a circular stapler, mechanical side to side anastomosis, etc), but none ofthese has become the gold standard [4-7] . This explains the difficulties encountered in promoting the widespread use of minimally invasive resection in western countries. Scientific societies insist on the need for prospective studies to establish the place of laparoscopy for gastric cancer (prophylactic gastrectomy for CDH-1 related gastric cancer, < T3 Tumours, palliative gastrectomy) [4] . Here, we present our technique for total resection of the stomach and D2 lymph node dissection, which allows the manualcreation of a feasible, safe, tension-free and effective esojejunal anastomosis. It can be performed by any surgeon familiar with laparoscopic surgery and the principles of oncologic resection. The cost is also relatively low because neither a circular staplernor other special equipment is required. Finally, the incision for extraction of the specimen can be placed in any area of the abdomen (usually through a supra-pubic incision in our practice).Keywords: Gastric cancer, laparoscopy, total gastrectomy, lymphadenectomy, Intracorporeal anastomosis.Total gastrectomy is the treatment of choice for adenocarcinoma of the upper and middle third of the stomach resected with curative intent. The laparoscopic approach allows satisfactory exploration of the peritoneal cavity and optimizes staging in borderline T3 or T4 tumours in patients affected by locally advanced tumours or intraperitoneal carcinomatosis. Laparoscopy can eliminate unnecessary laparotomies in 10 % of patients affected by these conditions with formal contraindications for resection [1] . Complete resection of the stomach associated with D2 lymph node dissection is also performed using a currently well-established technique [2, 3] . The specificity of laparoscopic gastric resection for cancer is that the stomach and the great omentum are withdrawn separately.Reconstruction of the digestive tract is more complex, and requires a variety of techniques (supra-umbilical mini-laparotomy, Orvil® technique, enlarging a port-site for passage of a circular stapler, mechanical side to side anastomosis, etc), but none of these has become the gold standard [4-7] . This explains the difficulties encountered in promoting the widespread use of minimally invasive resection in western countries. Scientific societies insist on the need for prospective studies to establish the place of laparoscopy for gastric cancer (prophylactic gastrectomy for CDH-1 related gastric cancer, < T3 Tumours, palliative gastrectomy) [4] . Here, we present our technique for total resection of the stomach and D2 lymph node dissection, which allows the manual creation of a feasible, safe, tension-free and effective esojejunal anastomosis. It can be performed by any surgeon familiar with laparoscopic surgery and the principles of oncologic resection. The cost is also relatively low because neither a circular stapler nor other special equipment is required. Finally, the incision for extraction of the specimen can be placed in any area of the abdomen (usually through a supra-pubic incision in our practice).Keywords: Gastric cancer, laparoscopy, total gastrectomy, lymphadenectomy, Intracorporeal anastomosis

Perception of epidemic's related anxiety in the General French Population: a cross-sectional study in the Rhône-Alpes region

International audienceBackgroundTo efficiently plan appropriate public health interventions during possible epidemics, governments must take into consideration the following factors about the general population: their knowledge of epidemics, their fears of and psychological responses to them, their level of compliance with government measures and their communities' trusted sources of information. However, such surveys among the French general population are rare.MethodsA cross-sectional study was conducted in 2006 in a representative sample of 600 subjects living in the Rhône-Alpes region (south-east France) to investigate self-reported knowledge about infectious diseases and anxiety generated by epidemic risk with particular reference to avian influenza. Data on reactions to potentially new epidemics and the confidence level in various sources of information were also collected.ResultsRespondents were most knowledgeable about AIDS, followed by avian influenza. Overall, 75% of respondents had adequate knowledge of avian influenza. The percentage was even higher (88%) among inhabitants of the Ain district, where an avian influenza epidemic had previously been reported. However, 39% expressed anxiety about this disease. In total, 20% of respondents with knowledge about avian influenza stated that they had changed their behaviours during the epizooty. Epidemics were perceived as a real threat by 27% of respondents. In the event of a highly contagious outbreak, the majority of respondents said they would follow the advice given by authorities. The study population expressed a high level of confidence in physicians and scientists, but had strong reservations about politicians, deputies and the media.ConclusionsAlthough the survey was conducted only four months after the avian influenza outbreak, epidemics were not perceived as a major threat by the study population. The results showed that in the event of a highly infectious disease, the population would comply with advice given by public authorities

Life-threatening hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy: report of a case

<p>Abstract</p> <p>Background</p> <p>Hemobilia is a rare but lethal biliary tract complication. There are several causes of hemobilia which might be classified as traumatic or nontraumatic. Hemobilia caused by pseudoaneurysm might result from hepatobiliary surgery or percutaneous interventional hepatobiliary procedures. However, to our knowledge, there are no previous reports pertaining to hemobilia caused by hepatic pseudoaneurysm after T-tube choledochostomy.</p> <p>Case presentation</p> <p>A 65-year-old male was admitted to our hospital because of acute calculous cholecystitis and cholangitis. He underwent cholecystectomy, choledocholithotomy via a right upper quadrant laparotomy and a temporary T-tube choledochostomy was created. However, on the 19th day after operation, he suffered from sudden onset of hematemesis and massive fresh blood drainage from the T-tube choledochostomy. Imaging studies confirmed the diagnosis of pseudoaneurysm associated hemobilia. The probable association of T-tube choledochostomy with pseudoaneurysm and hemobilia is also demonstrated. He underwent emergent selective microcoils emobolization to occlude the feeding artery of the pseudoaneurysm.</p> <p>Conclusions</p> <p>Pseudoaneurysm associated hemobilia may occur after T-tube choledochostomy. This case also highlights the importance that hemobilia should be highly suspected in a patient presenting with jaundice, right upper quadrant abdominal pain and upper gastrointestinal bleeding after liver or biliary surgery.</p

Rapport général. Influence de la modification par les gaz et les poussières industrielles de l'atmosphère hydrométéorologique

Facy L. Rapport général. Influence de la modification par les gaz et les poussières industrielles de l'atmosphère hydrométéorologique. In: Influence des activités de l'homme sur le cycle hydrométéorologique. Compte rendu des treizièmes journées de l'hydraulique. Paris, 16-18 septembre 1974. Tome 1, 1975

Rapport II.4. Le point actuel des recherches sur la physique des nuages. Application à la stimulation artificielle des précipitations

Discussion actual state about the efficiency of methods that lead either to dispel clouds, or to change precipitation amounts or nature. Recall of “ evaporation-condensation-precipitation” processes physical conditions. Precipitations starting mechanism according to Bergeron. Parameters to be controlled in order to make sure and successful a rain stimulation ; acting methods on “cold” (super-cooled drops) and “hot” clouds ; difficulty of an accurate and objective checking. Obtained to day results due to men acting on orographical, convective or depending from frontal systems clouds.Etat actuel de la controverse sur l’efficacité des méthodes tendant soit à dissiper les nuages, soit à modifier l’importance ou la nature des précipitations. Rappel des conditions physiques des processus «évaporation-condensation-précipitation». Le mécanisme du déclenchement des précipitations selon Bergeron. Les paramètres à contrôler pour assurer le succès d’une opération de stimulation de la pluie ; méthodes d’action sur les nuages «froids» (gouttelettes surfondues) et les nuages «chauds» ; difficulté d’un contrôle précis et objectif. Résultats obtenus à ce jour par l’action de l’homme sur les nuages orographiques, convectifs ou appartenant à des systèmes frontaux.Facy L. Rapport II.4. Le point actuel des recherches sur la physique des nuages. Application à la stimulation artificielle des précipitations. In: Influence des activités de l'homme sur le cycle hydrométéorologique. Compte rendu des treizièmes journées de l'hydraulique. Paris, 16-18 septembre 1974. Tome 1, 1975

Le rôle de la tension superficielle dans la physique des nuages et des précipitations

The role of surface tension in cloud physics and precipitation. Surface tension is one of the determining factors in the thermodynamics of atmospheric water condensation. The greater part of the work required in cloud droplet formation is taken up by the surface energy of the condensed phase and surface tension, modified by electrical charges, impurities or the growing drop diameter itself, is the determining factor of the behaviour of the different condensation nuclei present in the atmosphere. Again, the determining factor in the nucléation of the ice phase in water clouds at sub-zero temperatures is the interfacial tension at the super-cooled ice-water separation surface. Finally, the stability of falling raindrops, their break-up and the resulting Langmuir “chain reaction”, also depend on surface tension, which is responsible, up to a certain critical diameter, for the cohesion of the precipitation particles.La tension superficielle est un des facteurs déterminants de la thermodynamique de la condensation de l'eau dans l'atmosphère. C'est la création de l'énergie superficielle des germes de la phase condensante qui absorbe la majeure partie du travail exigé pour la formation des gouttelettes nuageuses ; c'est la tension de surface, modifiée par les charges électriques, par les impuretés ou par le diamètre même de la gouttelette-germe qui conditionne le comportement des différents noyaux de condensation présents dans l'atmosphère. C'est aussi la tension interfaciale glace-eau surfondue qui est le facteur déterminant de la nucléation de la phase glace dans les nuages d'eau à température négative. Enfin la stabilité des gouttes de pluie au cours de leur chute, leur rupture et par suite le mécanisme de « réaction en chaîne » de Langmuir, dépendent également de la tension superficielle qui assure, jusqu'à un certain diamètre seulement, la cohésion de l'élément de précipitation.Facy L. Le rôle de la tension superficielle dans la physique des nuages et des précipitations. In: Bulles et gouttes. La tension superficielle en hydraulique. Compte rendu des septièmes journées de l'hydraulique. Paris, 4, 5 et 6 juin 1962. Tome 2, 1963