Hypophosphatémie après résection hépatique

Introduction : L’hypophosphatémie survient couramment après hépatectomie partielle. La régénération du foie était l’explication initiale. Cependant, les pertes rénales de phosphate observées récemment suggèrent que l’hypophosphatémie est probablement d’origine rénale. Nous avons donc mesuré la fraction d’excrétion urinaire de phosphate (FePO4) après hépatectomie partielle et nous avons étudié le rôle de la parathormone (PTH) et des phosphatonines dans cette hypophosphatémie. Méthodes : Les taux sériques de phosphate, de calcium ionisé, de PTH intacte, de « fibroblast growth factor- 23 » (FGF-23) intact et carboxyle-terminal, de FGF-7, de la « frizzled-related protein-4 » (FRP-4) et de HCO3- ainsi que le pH et la FePO4 ont été mesurés avant la chirurgie et aux jours postopératoires (po) 1, 2, 3, 5 et 7, chez 18 patients ayant subi une résection hépatique partielle. Résultats : Le phosphate sérique était à son plus bas niveau (0,66 ± 0,33 mmol/l; p < 0,001) au jour po 2. La FePO4 culminait à 25,07 ± 2,26 % au jour po 1 (p < 0,05) et était associée avec le taux de la parathormone intacte (r = 0,65; p = 0,006). Le calcium ionisé sérique diminuait à 1,1 ± 0,01 mmol/l, (p < 0,01) en même temps que la parathormone intacte s’élevait à 8,8 ± 0,9 pmol/l, (p < 0,01) au jour po 1; ces deux paramètres étaient inversement corrélés (r = -0,062; p = 0,016). Le FGF-23 intact atteignait son plus bas niveau à 7,8 ± 6,9 pg/ml (p < 0,001), au jour po 3; les valeurs de FGF-23 étaient corrélées avec la diminution du phosphate sérique aux jours po 0, 3, 5 et 7 (p < 0,001). Le FGF-23 carboxyle-terminal, le FGF-7 et la FRP-4 n’étaient pas reliés au phosphate sérique ni à la FePO4. Conclusion : L’hypophosphatémie observée après résection hépatique partielle est liée à une augmentation de la FePO4 qui est sans aucune relation avec les FGF-23 intact ou carboxyle-terminal, le FGF-7 et la FRP-4. La PTH intacte était associée avec la FePO4 uniquement au jour po 1. L’hypophosphatémie après résection hépatique est secondaire à d’autres facteurs non encore identifiés.Background: Post-hepatectomy hypophosphatemia, first associated with metabolic demands by the regenerating liver, has recently been related to an excessive fractional urinary phosphate excretion (FePO4). We decided to investigate the role of parathyroid hormone (PTH) and of phosphatonins in the latter finding. Methods: Serum phosphate (PO4), ionized calcium (Ca++), HCO3-, pH and FePO4, Intact PTH, carboxyl-terminal and Intact fibroblast growth factor 23 (FGF-23), FGF-7 and frizzled related-protein-4 (FRP-4) were measured before and serially on post-operative days 1, 2, 3, 5 and 7, in 18 patients undergoing liver resection. Results: Serum PO4 was lowest (0.66 ± 0.33 mmol/l; p < 0.001) on po day 2. FePO4 peaked at 25.07 ± 2.26 % on po day 1 (p < 0.05) and was associated with Intact PTH levels (r = 0.65, p = 0.006). Decreased Ca++ levels (1.1 ± 0.01 mmol/l; p < 0.01) and increased Intact PTH levels (8.8 ± 0.9 pmol/l; p < 0.01) observed on po day 1 were negatively related (r = -0.62, p = 0.016). Intact FGF-23 decreased to its nadir 7.8 ± 6.9 pg/ml (p < 0.001), on po day 3 and was correlated with PO4 levels on po days 0, 3, 5 and 7 (p < 0.001). Carboxyl-terminal FGF-23, FGF-7 and FRP-4 levels could not be related either to PO4 concentrations or FePO4. Conclusion: Post-hepatectomy hypophosphatemia is related to an increased FePO4 unrelated to Intact FGF-23 or carboxyl-terminal FGF-23, FGF-7 or FRP-4. I-PTH contributes to excessive FePO4 on po day 1 but not thereafter. Other factors not yet defined should explain post hepatectomy hypophosphatemia

Survie et complications médicales à long terme : 10 ans après transplantation hépatique

Intoduction: Les comorbidités médicales longtemps après transplantation hépatique (THO), restent peu explorées. Méthodes: Analyse de 54 patients transplantés du foie entre juillet 1987 et décembre 1993. Résultats: 37 patients (68,5%) étaient vivants à 10 ans; à ce moment du suivi, 20 (55,5 %) étaient traités pour HTA, 2 (5,5 %) pour diabète, 6 (16,6 %) pour dyslipidémie, 4 (12,1 %) et 5 (15,6 %) pour ostéoporose lombaire et fémorale respectivement et 6 (16,6 %) pour détérioration de la fonction rénale (GFR < 40ml/min), dont 2 ont eu une transplantation rénale. Les causes principales de décès tardifs ont été l'insuffisance hépatocellulaire sur récidive de la maladie initiale (3), les maladies cérébrovasculaires (3) et les maladies tumorales (3). Conclusion: l'état de santé des patients à 10 ans s'est avéré satisfaisant. L'importance des comorbidités médicales recensées plaide en faveur d'un suivi à vie par une équipe spécialisée

Carcinoid tumor of the common bile duct: A rare complication of von Hippel-Lindau syndrome

Von Hippel-Lindau syndrome (VHL) is a rare autosomal-dominant, inherited familial cancer syndrome. Hemangioblastomas, pheochromocytomas and renal carcinoma are the frequent reported VHL tumors. Neuroendocrine tumors have also been described, mostly in the pancreas and rarely in the biliary trees. We report the second case of bile duct carcinoid in a 31-year-old VHL woman. She underwent right adrenalectomy for a pheochromocytoma in the past. She also had a positive family history of phenotypic expression of VHL syndrome. The patient presented with biliary colic. Endoscopic retrograde cholangio-pancreatography showed intra-luminal bile duct mass. Surgical exploration identified a beige nodular lesion that was a carcinoid tumor on histology. This new association should be clarified by further genetic investigations

Chemical Characterization, Antioxidant, Insecticidal and Anti-Cholinesterase Activity of Essential Oils Extracted from <i>Cinnamomum verum</i> L.

This study is aimed at evaluating the potential of the essential oil of Cinnamomum verum (EOCV) as an antioxidant, as an insecticide against Callosobruchus maculatus and for its anti-acetylcholinesterase activity. To this end, EOCV was extracted via hydrodistillation from this plant, and the identification of the phytochemicals was performed using gas chromatography–mass spectrometry (GC–MS). The antioxidant power was determined via in vitro tests, the insecticidal ability was tested via exposing C. maculatus to EOCV, and molecular docking was used to evaluate the anti-cholinesterase ability. The results of these GC–MS analyses show that the main composition of EOCV comprises Cinnamaldehyde dimethyl acetal (64.50%), cinnamicaldehyde (35.04%) and α-Copaene (0.11%). The insecticidal potential of the studied OEs, determined by using the inhalation test, and expressed as the concentration of EOs required for the death of 50% of the insects (LC50) and that required the death of 95% of adults (LC95) after 96 h of exposure, was 3.99 ± 0.40 and 14.91 ± 0.10 μL/L of air, respectively. In the contact test, 96 h of exposure gave an LC50 and LC95 of 3.17 ± 0.28 and 8.09 ± 0.05 μL/L of air, respectively. A comparison of the antioxidant activity of EOCV to that of ascorbic acid via DPPH free radical scavenging ability and Ferric Reducing Antioxidant Power (FRAP) revealed the IC50 and EC50 values of EOCV to be much higher than that obtained for ascorbic acid, and the molecular docking simulation revealed Coumarin, Piperonal, Cinnamaldehyde dimethyl and alpha-Copaene as possessing potential inhibitory activities against human acetylcholinesterase. However, further experimental validation is needed to enhance the prospects of this study

Promising Insecticidal Properties of Essential Oils from <i>Artemisia aragonensis</i> Lam. and <i>Artemisia negrei</i> L. (Asteraceae) by Targeting Gamma-Aminobutyric Acid and Ryanodine Receptor Proteins: <i>In Vitro</i> and <i>In Silico</i> Approaches

Artemisia negrei (A. negrei) and Artemisia aragonensis (A. aragonensis) are in the family Asteraceae, which has been used in traditional medicine. The use of plant-derived insecticides has become a promising strategy to reduce the harmful effects of synthetic insecticides and overcome the bio-resistance of pest insects to insecticides. In this regard, the purpose of the current study was to determine the chemical composition and evaluate insecticidal effects of essential oils (EOs) extracted from A. negrei (EON) and A. aragonensis (EOA). Notably, all chemical constituents present in the EOs were identified through GC-MS analysis, whilst the insecticidal properties against Callosobruchus maculatus Fab. (C. maculatus) were investigated by use of in vitro an in silico approaches. The obtained results showed that both tested EOs present a significant insecticidal effect against C. maculatus, which increased significantly upon the dose used in both contact and inhalation tests. The lethal concentrations (LC50) for the inhalation test were found to be 2.1 and 2.97 μL/L, while in the contact test they were 2.08 and 2.74 μL/L of air for EON and EOA, respectively. At 5 μL/L of air, the spawn reduction rate was 88.53 % and 77.41%, while the emergence reduction rate was 94.86% and 81.22% by EON and EOA, respectively. With increasing doses of up to 20 μL/L of air, the reduction in individual emergence reached 100% by the two oils tested after 36 h of treatment. In addition, Molecular docking (MD) simulations supported the in vitro findings and indicated that certain identified components in EOA and EON exhibited stronger hydrogen bonding interactions with the target receptors. Interestingly, the prediction of ADMET properties indicates that the molecules investigated have great pharmacokinetic profiles with no side effects. Taken together, our findings suggest that EOA and EON may exert both potential contact and inhalation insecticidal actions and could be used as an alternative tool for the control of this major insect pest of stored products

Hypertrophy of the non-embolized liver after chemotherapy

AbstractBackgroundNeoadjuvant chemotherapy (NC+) and portal vein embolization (PVE) enables curative resection in more patients with colorectal-liver metastases (CRLM). However, after NC+, structural alterations have been reported with the risk of post-operative hepatic failure. We undertook to determine if NC+ toxicity limits future remnant liver (FRL) hypertrophy after PVE.MethodsPVE was performed in 20 patients, 13 (65%) of whom previously received a mean FOLFIRI (5-fluorouracil + leucovorin + irinotecan) regimen (NC+) of 6.6 cycles. The seven remaining patients served as the control group without NC (NC−).ResultsCRLM were bilateral in 69% (NC+) and 57% (NC−), and synchronous in 84% (NC+) and 14% (NC−). The FRL hypertrophy rate was 54.1% (NC+) and 43.7% (NC−) (P= 0.3). CRLM were unresectable in four of our 20 patients, i.e. group NC+: one insufficient FRL hypertrophy and one severe steatosis; and group NC−: two tumoral progressions. In both groups, the operative parameters were comparable except for pedicular clamping: 8 (NC+) and 36min (NC−), respectively (P < 0.05). Also, the surgical outcome rate and hospital stay were comparable. No significant pathological difference was observed between the two groups. No mortality occurred in either group.ConclusionIn view of our limited experience, we conclude that hypertrophy of the non-embolized liver (FRL) is not altered after FOLFIRI-based NC