Arteriovenous Malformation of the Pancreas

Pancreatic arteriovenous malformation (PAVM) is a very rare and mostly congenital lesion, with less than 80 cases described in the English-published literature. It is defined as a tumorous vascular abnormality that is constructed between an anomalous bypass anastomosis of the arterial and venous networks within the pancreas. It represents about 5% of all arteriovenous malformations found in the gastrointestinal tract. Herein, we present a 64-year-old patient with symptomatic PAVM involving the body and tail of the organ, which was successfully treated by transcatheter arterial embolization. The disease spectrum and review of the literature are also presented

Endopancreatic Bile Duct Cholangiocarcinoma in a Patient with Peutz-Jeghers Syndrome

Peutz-Jeghers syndrome is a rare autosomal dominant inherited disease characterized by a special type of hamartomatous gastrointestinal polyps combined with mucocutaneous melanin pigmentations. Patients with the syndrome have a high risk of developing neoplasia, with colon, small bowel, and stomach being the most common gastrointestinal sites. Herein, we present the occurrence of a rare tumor in patients with Peutz-Jeghers syndrome; a cholangiocarcinoma of the endopancreatic bile duct. A minireview is also presented. It can be concluded that cholangiocarcinoma remains a possible diagnosis in PJS patients, as in others that present with biliary obstruction. PJS patients may be at higher risk than others in view of their propensity for malignancy

Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Increased expression of toll-like receptors 2, 3, 4 and 7 mRNA in the kidney and intestine of a septic mouse model

Toll-like receptors (TLRs) are key regulators of innate and adaptive immunity and are highly expressed during sepsis. Thus, studying the expression of TLRs in an animal septic model might indicate their possible association with acute kidney injury (AKI) in sepsis. Methods: Seventy-two male C57BL/6J mice were used for this study. Randomly, these animals were divided into 6 groups (N=12/group): 3 control and 3 septic groups depending on the euthanasia time (24h, 48h, 72h). Septic groups underwent cecal ligation and puncture (CLP) to induce peritonitis, while control groups had a sham operation. Hematological tests were performed in serum for immune biomarkers; immunofluorescence (IF), morphometry and qRT-PCR analysis was used on both kidney and intestine tissues to evaluate the expression of TLRs 2, 3, 4 and 7 in a septic process. Results: At the end of each experimental period, we found that TLRs 2, 3, 4 and 7 were expressed in both tissues but there were differences between those at various time points. Also, we found that mRNA levels were significantly higher in qRT-PCR evaluation in septic groups than control groups in both kidney and intestinal tissues; showing a steady increase in the septic groups as time to euthanasia was prolonged (p<0.05). Conclusion: Overall, our study provides a suggestion that TLRs 2, 3, 4 and 7 are highly increased in the kidneys of septic mice and especially, that these TLRs are sensitive and specific markers for sepsis. Finally, our study supports the diagnostic importance of TLRs in AKI and provides new data about them in septic mice models and in multi organ dysfunction syndrome (MODS) in general.Οι υποδοχείς τύπου Toll (TLRs) είναι βασικοί ρυθμιστές της φυσικής και επίκτητης ανοσίας και εκφράζονται έντονα κατά τη διάρκεια της σηψαιμίας. Έτσι, η μελέτη της έκφρασης των TLRs σε ένα ζωικό μοντέλο σήψης μπορεί να υποδεικνύει την πιθανή τους συσχέτιση με την οξεία νεφρική ανεπάρκεια (ΟΝΑ) σε μια σηπτική κατάσταση. Υλικό-Μέθοδοι: Σε αυτή τη μελέτη χρησιμοποιήθηκαν 72 αρσενικοί μύες C57BL/6J. Τυχαία, τα ζώα χωρίστηκαν σε 6 ομάδες (N = 12/ομάδα): 3 ομάδες ελέγχου και 3 σηπτικές ομάδες ανάλογα με το χρόνο ευθανασίας (24 ώρες, 48 ώρες και 72 ώρες). Οι σηπτικές ομάδες υποβλήθηκαν σε διαδικασία απολίνωσης και διάτρησης του τυφλού με βελόνη (CLP) για την πρόκληση περιτονίτιδας, ενώ οι ομάδες ελέγχου υποβλήθηκαν σε πλασματική επέμβαση. Διεξήχθησαν αιματολογικές εξετάσεις στον ορό για ανίχνευση βιοδεικτών ανοσίας. Τα αποτελέσματα του ανοσοφθορισμού (IF), της μορφομετρίας και της ποσοτικής αντίδρασης αλυσίδας πολυμεράσης πραγματικού χρόνου (qRT-PCR) αξιολογήθηκαν σε νεφρικούς και εντερικούς ιστούς για την έκφραση των TLR 2, 3, 4 και 7 κατά τη διάρκεια της σήψης. Αποτελέσματα: Στο τέλος κάθε πειραματικής περιόδου, διαπιστώσαμε ότι οι TLRs 2, 3, 4 και 7 εκφράζονται και στους δύο ιστούς με διαφορές τόσο μεταξύ τους όσο και μεταξύ των χρονικών σημείων. Επίσης βρήκαμε ότι τα επίπεδα του mRNA ήταν σημαντικά υψηλότερα στην αξιολόγηση της qRT-PCR στις σηπτικές ομάδες από ό,τι στις ομάδες ελέγχου τόσο στους νεφρούς όσο και στους εντερικούς ιστούς, παρουσιάζοντας μια σταθερή αύξηση στις σηπτικές ομάδες καθώς ο χρόνος ευθανασίας παρατείνετο (p <0,05). Συμπέρασμα: Συνολικά, η μελέτη μας υποστηρίζει ότι η έκφραση των TLRs 2, 3, 4 και 7 εκφράζεται σε μεγάλο βαθμό στους νεφρούς των σηπτικών μυών και ειδικότερα ότι αυτοί οι TLRs είναι ευαίσθητοι και ειδικοί δείκτες για τη σηψαιμία. Επίσης, η μελέτη μας ενισχύει τη διαγνωστική σημασία των TLRs στην ΟΝΑ καιπαρέχει νέα δεδομένα για αυτούς σε μοντέλα σηπτικών μυών και κατά επέκταση στην ανεπάρκεια πολλαπλών οργάνων (MODS)

Ιστικός και ποσοτικός προσδιορισμός των TLRs στο έντερο και στους νεφρούς σε σηπτικά μοντέλα μυών: πειραματική μελέτη

Εισαγωγή: Οι υποδοχείς τύπου Toll (TLRs) είναι βασικοί ρυθμιστές της φυσικής και επίκτητης ανοσίας και εκφράζονται έντονα κατά τη διάρκεια της σηψαιμίας. Έτσι, η μελέτη της έκφρασης των TLRs σε ένα ζωικό μοντέλο σήψης μπορεί να υποδεικνύει την πιθανή τους συσχέτιση με την οξεία νεφρική ανεπάρκεια (ΟΝΑ) σε μια σηπτική κατάσταση. Υλικό-Μέθοδοι: Σε αυτή τη μελέτη χρησιμοποιήθηκαν 72 αρσενικοί μύες C57BL/6J. Τυχαία, τα ζώα χωρίστηκαν σε 6 ομάδες (N = 12/ομάδα): 3 ομάδες ελέγχου και 3 σηπτικές ομάδες ανάλογα με το χρόνο ευθανασίας (24ώρες, 48ώρες και 72ώρες). Οι σηπτικές ομάδες υποβλήθηκαν σε διαδικασία απολίνωσης και διάτρησης του τυφλού με βελόνη (CLP) για την πρόκληση περιτονίτιδας, ενώ οι ομάδες ελέγχου υποβλήθηκαν σε πλασματική επέμβαση. Διεξήχθησαν αιματολογικές εξετάσεις στον ορό για ανίχνευση βιοδεικτών ανοσίας. Τα αποτελέσματα του ανοσοφθορισμού (IF), της μορφομετρίας και της ποσοτικής αντίδρασης αλυσίδας πολυμεράσης πραγματικού χρόνου (qRT-PCR) αξιολογήθηκαν σε νεφρικούς και εντερικούς ιστούς για την έκφραση των TLR 2, 3, 4 και 7 κατά τη διάρκεια της σήψης. Αποτελέσματα: Στο τέλος κάθε πειραματικής περιόδου, διαπιστώσαμε ότι οι TLRs 2, 3, 4 και 7 εκφράζονται και στους δύο ιστούς με διαφορές τόσο μεταξύ τους όσο και μεταξύ των χρονικών σημείων. Επίσης βρήκαμε ότι τα επίπεδα του mRNA ήταν σημαντικά υψηλότερα στην αξιολόγηση της qRT-PCR στις σηπτικές ομάδες από ό,τι στις ομάδες ελέγχου τόσο στους νεφρούς όσο και στους εντερικούς ιστούς, παρουσιάζοντας μια σταθερή αύξηση στις σηπτικές ομάδες καθώς ο χρόνος ευθανασίας παρατείνετο (p &lt;0,05). Συμπέρασμα: Συνολικά, η μελέτη μας υποστηρίζει ότι η έκφραση των TLRs 2, 3, 4 και 7 εκφράζεται σε μεγάλο βαθμό στους νεφρούς των σηπτικών μυών και ειδικότερα ότι αυτοί οι TLRs είναι ευαίσθητοι και ειδικοί δείκτες για τη σηψαιμία. Επίσης, η μελέτη μας ενισχύει τη διαγνωστική σημασία των TLRs στην ΟΝΑ και παρέχει νέα δεδομένα για αυτούς σε μοντέλα σηπτικών μυών και κατά επέκταση στην ανεπάρκεια πολλαπλών οργάνων (MODS).Background: Toll-like receptors (TLRs) are key regulators of innate and adaptive immunity and are highly expressed during sepsis. Thus, studying the expression of TLRs in an animal septic model might indicate their possible association with acute kidney injury (AKI) in sepsis. Methods: Seventy-two male C57BL/6J mice were used for this study. Randomly, these animals were divided into 6 groups (N=12/group): 3 control and 3 septic groups depending on the euthanasia time (24h, 48h, 72h). Septic groups underwent cecal ligation and puncture (CLP) to induce peritonitis, while control groups had a sham operation. Hematological tests were performed in serum for immune biomarkers; immunofluorescence (IF), morphometry and qRT-PCR analysis was used on both kidney and intestine tissues to evaluate the expression of TLRs 2, 3, 4 and 7 in a septic process. Results: At the end of each experimental period, we found that TLRs 2, 3, 4 and 7 were expressed in both tissues but there were differences between those at various time points. Also, we found that mRNA levels were significantly higher in qRT-PCR evaluation in septic groups than control groups in both kidney and intestinal tissues; showing a steady increase in the septic groups as time to euthanasia was prolonged (p&lt;0.05). Conclusion: Overall, our study provides a suggestion that TLRs 2, 3, 4 and 7 are highly increased in the kidneys of septic mice and especially, that these TLRs are sensitive and specific markers for sepsis. Finally, our study supports the diagnostic importance of TLRs in AKI and provides new data about them in septic mice models and in multi organ dysfunction syndrome (MODS) in general

One-Anastomosis Gastric Bypass Revision for Gastroesophageal Reflux Disease: Long Versus Short Biliopancreatic Limb Roux-en-Y Gastric Bypass

International audienceAbstractPurposeOne-anastomosis gastric bypass (OAGB) may be associated with refractory gastroesophageal reflux disease (GERD). The nature of this GERD remains unclear. This complication can be treated either with an additional enteroenterostomy without shortening of gastric pouch (long biliopancreatic limb Roux-en-Y gastric bypass (L-BPL-RYGB)) or revision to conventional short biliopancreatic limb Roux-en-Y gastric bypass (S-BPL-RYGB). The objective of this study is to compare the aforementioned procedures in terms of efficacy on GERD symptoms.Materials and MethodsRetrospective analysis between October 2012 and June 2020.ResultsFifty-two patients underwent OAGB revision to S-BPL-RYGB (n = 21) or L-BPL-RYGB (n = 31) secondary to GERD. Investigation with pH impedance prior to revision was performed in 15 patients showing biliary reflux (BR) in 7 (46.6%), acid reflux (AR) in 6 (40%), and no confirmation in 2. Patients with AR had a revision to S-BPL-RYGB, whereas patients with BR underwent L-BPL-RYGB. Among the patients without pH metry results (n = 37), S-BPL-RYGB was performed for associated disabling digestive disorders or nutritional deficiencies. GERD was treated in 68% of patients with L-BPL-RYGB versus 95% of patients after S-BPL-RYGB. Patients, whose decision for revisional procedure was based on the results of pH impedance testing, did not reveal refractory GERD.ConclusionL-BPL-RYGB seems appropriate in patients with BR, whereas conversion to S-BPL-RYGB should be preferred if AR is present

150-cm Versus 200-cm Biliopancreatic Limb One-Anastomosis Gastric Bypass: Propensity Score–Matched Analysis

International audienceBackgroundIt has been suggested that shortening the length of the biliopancreatic limb (BPL) to 150 cm in one anastomosis gastric bypass (OAGB) would reduce nutritional complication rates without impairing weight loss outcomes. The aim of this study is to compare patients who underwent OAGB with a 200-cm BPL (OAGB-200) to patients with OAGB with a 150-cm BPL (OAGB-150) in terms of weight loss and late morbidity.MethodsThis is a monocentric retrospective matched cohort study including patients with a body mass index between 35 and 50 kg/m2 who underwent an OAGB-150 or an OAGB-200. Patients were matched 1:1 based on age, sex, and body mass index, prior to bariatric surgery.ResultsIn total, 784 patients who underwent OAGB were included (OAGB-150 n = 392 and OAGB-200 (n = 392). There was no significant difference in terms of early morbidity. Regarding late morbidity in patients with an OAGB-150, significantly lower rates for marginal ulcer (OR = 0.4, CI 95% [0.2; 0.8], p = 0.006), incisional hernia (OR = 0.5, CI 95% [0.3; 1], p = 0.041), and bowel obstruction (OR = 0.3, CI 95% [0.1; 0.9], p = 0.039) were reported. Likewise, regarding late nutritional deficiencies, post-OAGB-150, a significantly lower number of patients with hypoalbuminemia (OR = 0.3, CI 95% [0.2; 0.7], p = 0.006), low vitamin B9 (OR = 0.5, CI 95% [0.2; 1], p = 0.044), and low ferritin (OR = 0.5, CI 95% [0.3; 0.8], p = 0.005) were observed. There was no significant difference in the percentage of excess BMI loss at 1, 2, 3, 4, and 5 years.ConclusionCompared to OAGB-200 in patients with BMI ≤ 50 kg/m2, OAGB-150 results in fewer nutritional deficiency rates long term, without impairing weight loss