Medetomidine-midazolam association in dogs: a reversible anaesthesic protocol allowing deep sedation

Poncet Cyrill, Bouvy Bernard, Dupré Gilles. Association médétomidine-midazolam chez le chien : un protocole d'anesthésie réversible permettant une sédation poussée. In: Bulletin de l'Académie Vétérinaire de France tome 156 n°2, 2003. pp. 75-77

Intraoperative carcinoid syndrome during small-bowel neuroendocrine tumour surgery

Only few descriptions of intraoperative carcinoid syndrome (ioCS) have been reported. The primary objective of this study was to describe ioCS. A second aim was to identify risk factors of ioCS. We retrospectively analysed patients operated for small-bowel neuroendocrine tumour in our institution between 2007 and 2015, and receiving our preventive local regimen of octreotide continuous administration. ioCS was defined as highly probable in case of rapid (<5 min) arterial blood pressure changes ≥40%, not explained by surgical/anaesthetic management and regressive ≥20% after octreotide bolus injection. Probable cases were ioCS which did not meet all criteria of highly-probable ioCS. Suspected ioCS were detected on the anaesthesia record by an injection of octreotide due to a manifestation which did not meet the criteria for highly-probable or probable ioCS. A total of 81 patients (liver metastases: 59, prior carcinoid syndrome: 49, carcinoid heart disease: 7) were included; 139 ioCS occurred in 45 patients: 45 highly probable, 67 probable and 27 suspected. ioCs was hypertensive (91%) and/or hypotensive (29%). There was no factor, including the use of vasopressors, significantly associated with the occurrence of an ioCS. All surgeries were completed and one patient died from cardiac failure 4 days after surgery. After preoperative octreotide continuous infusion, ioCS were mainly hypertensive. No ioCS risk factors, including vasopressor use, were identified. No intraoperative carcinoid crisis occurred, suggesting the clinical relevance of a standardized octreotide prophylaxis protocol

Re-interventions laparoscopiques pour dysphagie persistante après cure de hernie hiatale (étude retrospective unicentrique à propos de 43 patients)

LYON1-BU Santé (693882101) / SudocSudocFranceF

Étude de la progression tumorale dans les tumeurs endocrines digestives (intérêt des modèles animaux de xénogreffe)

Les tumeurs endocrines digestives constituent un groupe de tumeurs rares et hétérogènes rendant difficile l établissement de grandes séries homogènes et informatives. De plus, un manque de connaissances fondamentales persiste concernant les mécanismes moléculaires et cellulaires de la tumorigénèse et de la progression tumorale. Notre objectif a été de mettre au point un modèle animal de tumeur endocrine digestive par xénogreffe orthotopique reproduisant les principales étapes de l histoire naturelle de ces tumeurs : invasion locale et dissémination métastatique et de l appliquer à l étude de la relation entre l activité angiogénique et la progression des tumeurs. Par sa forte similitude avec la situation clinique, ce modèle présente un intérêt majeur pour l identification et le développement de nouveaux marqueurs pour le diagnostic (imagerie), l évaluation du pronostic (marqueurs moléculaires) et le traitement de ces tumeurs (tests pharmacologiques)Digestive endocrine tumors are a rare and heterogeneous group of human tumors, and this is a major limitation for their study. In addition, many aspects of tumoral evolution, including molecular and cellular determinants are poorly understood at the present time. The aim of our experimental approach was to develop an animal model of digestive endocrine tumor, using heterotopic xenografts, reproducing all the different steps of tumoral progression: local invasion and metastatic dissemination. In particular, this model was used for the study of angiogenesis during the natural history of this specific kind of highly vascularized tumors. Recalling its human counterpart, our model is of great relevance for the identification of new diagnostic or prognostic markers, together with the development of new therapeutic approachesLYON1-BU.Sciences (692662101) / SudocSudocFranceF

Études structurales et fonctionnelles de la NAD Kinase 1 de Listeria monocytogènes (vers une conception rationnelle de ligands utilisant une approche par fragment)

Dans le contexte du séquençage rapide des génomes et de la recherche d antibiotiques, la caractérisation de nouvelles cibles thérapeutiques doit être rationalisée et accélérée. Le travail présenté a consisté à mettre en place des outils pour la détermination rapide de structures des ligands optimaux pour une cible. Nous avons allié la cristallographie des complexes avec de la chimie combinatoire focalisée. Une application a été faite sur les NAD kinases dont le clonage est récent. Les différentes structures d une NAD kinase Gram(+), L. monocytogenes, ont été déterminée en présence de son substrat (NAD+), de son produit (NADP+), d ATP seul et de dérivés de l adénosine. Ces complexes ont permis de mieux décrire le site actif de la protéine, d apporter des précisions sur le mécanisme enzymatique, de révéler la formation d un nouveau composé biologique de fonction inconnue (2 p-ATP) et de caractériser le premier complexe d une NAD kinase avec un inhibiteur le di-(5 -thioadénosine).MONTPELLIER-BU Pharmacie (341722105) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Recent trends in the treatment of well-differentiated endocrine carcinoma of the small bowel

Well-differentiated endocrine carcinomas of the small bowel are fairly rare neoplasms that present many clinical challenges. They secrete peptides and neuroamines that may cause carcinoid syndrome. However, many are clinically silent until late presentation with major effects. Initial treatment aims to control carcinoid syndrome with somatostatin analogs. Even if there is metastatic spread, surgical resection of the primitive tumor should be discussed in cases of retractile mesenteritis, small bowel ischemia or subocclusive syndrome in order to avoid any acute complication, in particular at the beginning of somatostatin analog treatment. The choice of treatment depends on the symptoms, general health of the patient, tumor burden, degree of uptake of radionuclide, histological features of the tumor, and tumor growth. Management strategies include surgery for cure (which is rarely achieved) or for cytoreduction, radiological interventions (transarterial embolization or radiofrequency ablation), and chemotherapy (interferon and somatostatin analogs). New biological agent and radionuclide targeted therapies are under investigation. Diffuse and non-evolving lesions should also be simply monitored. Finally, it has to be emphasized that it is of the utmost importance to enroll these patients with a rare disease in prospective clinical trials assessing new therapeutic strategies

Symposium on Penalization and Applications

COMInternational audienc

Laparoscopic Treatment of Gastro-Gastric Fistula After RYGB: Technical Points

International audiencePostoperative abdominal pain after Roux en Y gastric bypass associated with gastro esophageal reflux is difficult to manage. A gastro-gastric fistula can be the etiology and besides pain and weight regain, it can also be revealed by a dilatation of the excluded stomach and duodenum. We present the case of a 45-year-old woman who had a medical history of revisional RYGB after failure of gastric band. She recently complained of recurrent epigastric abdominal pain and biliary GERD. Upper gastro intestinal endoscopy found biliary reflux gastritis. The CT scan with gas expansion and opacification revealed a dilated excluded stomach and duodenum leading to the diagnosis of gastro-gastric fistula. Because of pain and GERD correlated to this radiological finding, we decided to perform an exploratory laparoscopy. The patient was placed in a half-sitting position, surgeon between the legs. A 12-mmHg pneumoperitoneum was made. A 4-port technique was used. The first step consisted of a complete adhesiolysis. The second step consisted in the dissection of the excluded stomach, stuck to the gastric pouch, and revealed two gastro-gastric fistulas treated by stapling. An epiploplasty was performed on the excluded stomach and the staple line of the gastric pouch was invaginated. Postoperative course was uneventful. One year later, she had no more reflux and no more pain. Causes of abdominal pain and GERD after RYGB are difficult to identify. Gastro-gastric fistula is one of them and should be evoked when biliary reflux and abdominal pain appear

Tolerance to crown gall differs among genotypes of rose rootstocks

International audienc