Treatment of tumour recurrence after resection of hepatocellular carcinoma. Analysis of 97 consecutive patients

OBJECTIVE: To evaluate the long-term results of aggressive treatment of HCC recurrence. METHODS: Two hundred and nine consecutive patients underwent hepatic resection for HCC in our hospital. Tumour recurrence was diagnosed in 97 (51%) of the 190 patients with curative resection. Sixteen underwent hepatic resection: two right hepatectomies, one three-segmentectomy, one left hepatectomy, five two-segmentectomies, six segmental resections and one subsegmentectomy. Two patients with metastasis in the spine were submitted to a vertebral body resection. Twenty-five patients were treated with percutaneous ethanol injection or intra-arterial chemoembolization. Fifty-four patients with a poor performance status and liver function or multiple extra hepatic recurrences did not receive any treatment. RESULTS: There were no operative deaths. The postoperative mortality rate was 5.5% (one patient). The cumulative overall survival after the second resection was respectively 89%, 46% and 31% at 1, 3 and 5 years. There was a significant difference in survival between patients treated with repeat resection and those submitted to a non-surgical or conservative treatment (p<0.0001). There were no differences in operative deaths, postoperative mortality and morbidity between the first and second hepatic resection. CONCLUSIONS: Aggressive management with combined resection or loco regional therapy for intrahepatic recurrence and resection of isolated extra-hepatic recurrence may offer long-term survival in selected patients. Second liver resection for recurrence of HCC can be safely performed

Cholecystectomy in sickle cell disease patients: Is there more acute chest syndrome after laparoscopy? A case controlled study

AbstractLaparoscopy is increasingly being recommended in order to reduce postoperative complications among sickle cell disease patients undergoing cholecystectomy. Acute chest syndrome is the most deadly of these complications. The purpose of this study was to assess if laparoscopic approach reduces postoperative complications related to sickle cell disease after cholecystectomy. A retrospective study of records of sickle cell patients who underwent cholecystectomy for cholelithiasis, from January 1990 to December 2005 was conducted. 136 sickle cell patients underwent surgery: 47 (34.5%) by laparoscopy and 89 (63.5%) by laparotomy. The mean operative time was 71.4±18.9min in the laparoscopy group and 61.2±15.3min in the laparotomy group (non-significant difference). The mortality was not significantly different between the two groups: one patient died in the open cholecystectomy group but no death occurred in the laparoscopic one. The morbidity related to the sickle cell disease was significantly higher in the laparoscopy group [n=5 (10.5%)] than in the laparotomy group [n=4 (4.5%)] (p=0.04). This difference was associated with a higher rate of acute chest syndrome in the laparoscopy group [n=4 (8, 5%)] compared to that in the laparotomy group [n=1 (1.1%)] (p=0.01). There were more complications related to sickle cell disease in the laparoscopy group due to acute chest syndrome. Thus, these data should be confirmed in further randomized studies which must be undertaken

A leader in an emerging new international market: the determinants of French wine exports, 1848–1938

The objective of this article is to provide an in-depth study of France''s performance in the new international wine market that began to take shape from the middle of the nineteenth century. We analyse the main determinants of its success in exporting ordinary and high-quality wine using a gravity model for both types of wine. The article shows how France lost foreign markets in the ordinary wine sector, due to difficulties in maintaining its exports, which resulted from the decrease in production caused by the phylloxera plague and increasing competition from growing numbers of producers who were more efficient at producing these types of wines. However, in the high-quality wine market, French exporters enjoyed considerable success, increasing their exports thanks to their efforts to offer a product that was highly valued abroad and the use of modern marketing and sales techniques. The exports benefited from the fall in transport costs and French colonial expansion. However, exports of both products were severely affected by a series of major events, including the First World War, the Russian Revolution, Prohibition in the US, and the Great Depression. This case study of the wine market shows that the collapse of the first globalization was not the same for all products

Le Chemin aux Errants, zone C (Haute-Normandie, Eure, Val-de-Reuil): Rapport de fouille 2015

International audienceLe site du « Chemin aux Errants » se trouve en fond de vallée de l’Eure, à une centaine de mètres du cours actuel de la rivière, en rive droite, sur un dôme naturel de grave. Intervenue entre 2011 et 2012, dans le cadre de l’extension d’une carrière de granulats de la société CEMEX, la fouille s’est effectuée sur une superficie d’un peu moins de 8 ha. Elle a fourni de nombreux éléments d’informations, allant du premier âge du Fer jusqu’au Moyen Âge, de manière plus ou moins discontinue. Ces données participent activement à la riche documentation de cette partie de la région, notamment pour ce que l’on appelle la boucle du Vaudreuil durant la période antique et surtout, alto-médiévale. Ce secteur de la confluence entre Seine et Eure révèle en effet une multitude de sites, néanmoins pour la plupart insuffisamment documentés, en raison des contraintes d’emprises