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Now showing items 1 - 12 of 12

  • Insights into fast-track colon surgery: a plea for a tailored program

    Pellegrino, L.   Lois, F.   Remue, C.   Forget, P.   Crispin, B.   Leonard, D.   Jamart, J.   Kartheuser, A.  

    This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay. This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Fran double dagger aise de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression. Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age > 69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001). The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
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  • Malone appendicostomy: an unexpected complication

    Orabi, N. Abbes   Paterson, H. M.   Goncette, L.   Danse, E.   Saey, J. P.   Kartheuser, A.  

    The Malone appendicostomy is a novel option for surgical management of faecal incontinence and chronic constipation, by permitting the administration of antegrade colonic enemas for colonic evacuation. We report the case of a 54-year-old female who had undergone abdomino perineal resection for low rectal cancer followed by total perineal reconstruction with perineal colostomy, dynamic double graciloplasty and Malone appendicostomy. After 7-year follow-up, functional results and quality of life scores were satisfactory. Suddenly the patient described increasing difficulty with intubation of her appendicostomy and complete reflux of the enema liquid, which radiology referred to a calcified body of 35 mm within the Malone appendicostomy causing nearly complete obstruction of the conduit. A surgical exploration was necessary to extract the fecolith allowing full recovery with return to satisfactory Malone appendicostomy function. To our knowledge, this is the first report of a fecolith causing obstruction within a Malone appendicostomy.
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  • Epiploic appendagitis

    Orabi, N. Abbes   Lardinois, C.   Danse, E.   Remue, C.   Leonard, D.   Kartheuser, A.  

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  • Altemeier's procedure for rectal prolapse: analysis of long-term outcome in 60 patients

    Ris, F.   Colin, J. -F.   Chilcott, M.   Remue, C.   Jamart, J.   Kartheuser, A.  

    Aim Altemeiers procedure (perineal rectosigmoidectomy) is the operation of choice for rectal prolapse in the elderly. The aims of this prospective observational study were to evaluate its long-term actuarial recurrence risk and the influence of the length of rectosigmoid resection and associated levatorplasty on recurrence rate and continence. Method The perioperative and long-term data for all patients undergoing Altemeiers procedure since 1992 were analysed with regard to mortality, morbidity, continence, anorectal function and recurrence rate. Results Sixty patients [median age 77 years (3598)] underwent rectosigmoid resection [median length of bowel 14 (660) cm] with associated levatorplasty in 21 (35%). Overall mortality and morbidity were 1.6 and 11.6%, respectively. Manometry showed increased anal sphincter basal pressure and maximal squeeze pressure. We observed a decrease in postoperative rectal compliance (P = 0.002). Age, gender, prolapse duration before surgery, levatorplasty and length of resection had no statistically significant relationship with recurrence. Continence improved in 62% and was stable over a median follow-up of 48 (1186) months. Continence was positively related to a short length of bowel resection, but not to decreased rectal compliance. Actuarial recurrence was 14% at 4 years. Conclusion The long-term recurrence rate after the Altemeier procedure was low and not linked to resection length or to levatorplasty. Improvement in continence was stable over time.
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  • Mucormycose en transplantation rénale : A propos d\"un cas

    Kartheuser, A.   Squifflet, J.P.   Pirson, Y.   Lefebvre, Y.   Zech, F.   Fievez, Cl.   Alexandre, G.P.J.  

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  • Total perineal reconstruction after abdominoperineal excision for rectal cancer: long-term results of dynamic graciloplasty with Malone appendicostomy

    Orabi, N. Abbes   Vanwymersch, T.   Paterson, H. M.   Mauel, E.   Jamart, J.   Crispin, B.   Kartheuser, A.  

    Aim This study aimed to assess long-term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. Method From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28-55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement 'WPASR' scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer 'EORTC' QLQ-C30 and QLQ-CR38 questionnaires). Results There was no procedure-related mortality. One patient required intra-abdominal re-operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease-free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time. Conclusion In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long-term function and QoL.
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  • A phase II study of preoperative oxaliplatin, capecitabine, and external beam radiotherapy in patients with locally advanced rectal adenocarcinoma: The RadiOxCape Study.

    Honhon, B.   Duck, L.   Coster, B.   Coche, J.-C.   Canon, J.-L.   Scalliet, P.   Sempoux, C.   Humblet, Y.   Kartheuser, A.   Machiels, J.-P.  

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  • Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: A tenyear experience: A.H. Kartheuser, R. Parc, C.P. Penna, et al. Surgery 119:615–623, (June), 1996

    Thomas F. Tracy Jr  

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  • Ileal pouch-anal anastomosis as the first choice operation in patients with familial adenomatous polyposis: A tenyear experience: A.H. Kartheuser, R. Parc, C.P. Penna, et al. Surgery 119:615–623, (June), 1996

    Thomas F. Tracy Jr  

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  • La polypose adénomateuse familiale prédispose à une exposition pathologiquede l’estomac à la bilirubine: J.Y. Mabrut, R. Romagnoli, J.M. Collard, J.C. Saurin, R. Detry, F. Mion, J. Baulieux, A. Kartheuser, Familial adenomatous polyposis predisposes to pathologic exposure of the stomach to bilirubin. Surgery 2006;140:818-823.

    C. Mariette   S. Benoist   Ph. De Mestier  

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  • La polypose adénomateuse familiale prédispose à une exposition pathologiquede l’estomac à la bilirubine: J.Y. Mabrut, R. Romagnoli, J.M. Collard, J.C. Saurin, R. Detry, F. Mion, J. Baulieux, A. Kartheuser, Familial adenomatous polyposis predisposes to pathologic exposure of the stomach to bilirubin. Surgery 2006;140:818-823.

    C. Mariette; S. Benoist; Ph. De Mestier  

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  • Phase I/II study of preoperative cetuximab, capecitabine, and external beam radiotherapy in patients with rectal cancer

    Machiels, J. -P.   Sempoux, C.   Scalliet, P.   Coche, J. -C.   Humblet, Y.   Van Cutsem, E.   Kerger, J.   Canon, J. -L.   Peeters, M.   Aydin, S.   Laurent, S.   Kartheuser, A.   Coster, B.   Roels, S.   Daisne, J. -F.   Honhon, B.   Duck, L.   Kirkove, C.   Bonny, M. -A.   Haustermans, K.  

    Background: To assess the safety and preliminary efficacy of concurrent radiotherapy, capecitabine, and cetuximab in the preoperative treatment of patients with rectal cancer. Patients and methods: Forty patients with rectal cancer (T3-T4, and/or N+, endorectal ultrasound) received preoperative radiotherapy (1.8 Gy, 5 days/week for 5 weeks, total dose 45 Gy, three-dimensional conformal technique) in combination with cetuximab [initial dose 400 mg/m(2) intravenous given 1 week before the beginning of radiation followed by 250 mg/m(2)/week for 5 weeks] and capecitabine for the duration of radiotherapy (650 mg/m(2) orally twice daily, first dose level; 825 mg/m(2) twice daily, second dose level). Results: Four and six patients were treated at the first and second dose level of capecitabine, respectively. No dose-limiting toxicity occurred. Thirty additional patients were treated with capecitabine at 825 mg/m(2) twice daily. The most frequent grade 1/2 side-effects were acneiform rash (87%), diarrhea (65%), and fatigue (57%). Grade 3 diarrhea was found in 15%. Three grade 4 toxic effects were recorded: one myocardial infarction, one pulmonary embolism, and one pulmonary infection with sepsis. Two patients (5%) had a pathological complete response. Conclusions: Preoperative radiotherapy in combination with capecitabine and cetuximab is feasible with some patients achieving pathological downstaging.
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