Marc Zalcman

Transoral gastroplasty is safe, feasible, and induces significant weight loss in morbidly obese patients: results of the second human pilot study

BACKGROUND AND STUDY AIMS Bariatric surgical treatments have been proven to induce long-term weight loss in morbidly obese patients, but complications are relatively frequent. We recently reported a first human multicenter trial assessing the safety, feasibility, and weight loss results of the Transoral Gastroplasty (TOGA) system (Satiety Inc., Palo Alto, CA) at 6 months. Here we report the 6-month results of the second phase of the pilot trial with the TOGA system, with technical improvements to the device. PATIENTS AND METHODS Patients met established criteria for bariatric surgery. The TOGA system, a set of transoral endoscopically guided staplers, was used to create a stapled restrictive pouch along the lesser curvature of the stomach. Follow-up was at 1 week and at 1, 3, and 6 months. At 3 months, re-treatment consisting in additional distal restrictions was allowed if necessary. RESULTS Data were available for 11 patients in our center (7 female, mean age 44.2 years, mean body mass index 41.6). The procedure was completed safely in all patients. There were no serious adverse events. Mean excess weight loss was 19.2 %, 33.7 %, and 46.0 % at 1, 3, and 6 months, respectively. Average body mass index decreased from 41.6 before treatment to 33.1 at 6 months. Absolute mean weight loss was 9.9 kg, 17.5 kg, and 24.0 kg at 1, 3, and 6 months, respectively. A dramatic improvement in quality-of-life measures was observed in all patients. CONCLUSIONS This second pilot trial confirmed the feasibility and safety of transoral gastroplasty. The early results and technical improvements reported in the present study are encouraging in terms of safety, early weight loss, and quality of life, and clearly allowed multicenter trials, which are planned to start soon.

Anatomic significance of a positive barium enema in deep infiltrating endometriosis of the large bowel.

PurposeThe anatomopathological significance of a positive double-contrast barium enema (DCBE) for suspicion of deep infiltrating endometriosis of the large bowel was studied. This is a retrospective study of a prospective database.MethodsA large-bowel resection was proposed for patients who were suspicious for large-bowel endometriosis and had a positive DCBE. In a series of 73 patients, 71 large-bowel resections were performed. Histology and immunohistochemistry with the monoclonal antibody CD-10 were performed on the resection specimen. Outcome measures were the length of the resected specimen, the largest diameter of the lesion, the positivity of the resection margins, and the degree of infiltration of the large bowel. We also compared the mean largest diameters of the lesions with the degree of infiltration of the large bowel.ResultsBetween December 1997 and October 2005, 80 patients were suspicious for large-bowel endometriosis: 73 (91%) had positive DCBEs, and 7 (9%) had negative DCBEs. Of the 73 with positive DCBEs, 4 (5%) refused digestive resection and 1 (1.4%) was excluded. Three patients underwent two large-bowel resections because of the presence of bifocal lesions (left and right colon). A total of 71 resections were performed. In case of positive DCBE, the perivisceral fat and the whole muscularis were infiltrated in 100% of cases. The infiltration reached the submucosa and the mucosa respectively in 82% and 18% of cases. A total of 9.9% of resection margins were positive at histology but only focally. The mean largest diameter of the lesions infiltrating the whole thickness of the large bowel was not statistically different from the mean largest diameter of more superficial lesions.ConclusionsFindings of mass effect with indentations and ridging of the mucosa on DCBE in a setting suspicious for large-bowel endometriosis correspond well with pathologic findings of deep infiltration of the large-bowel wall. Clinicians dealing with deep infiltrating endometriosis should be aware of these findings, which could influence their choice of surgical treatment.

Delayed enhancement of the bowel wall: A new CT sign of small bowel strangulation

PURPOSE To report a new CT sign of small bowel strangulation. MATERIALS AND METHODS Two cases of small bowel obstruction evaluated by spiral CT with intravenous contrast injection. RESULTS In both cases we observed an absence of parietal enhancement of the diseased bowel loop, visible on early scans only. This feature was accompanied by signs of bowel obstruction. The two patients had a segment of necrotic ileum resected. CONCLUSION Delayed enhancement of a bowel loop in cases of small bowel obstruction should suggest the diagnosis of strangulation and lead to rapid surgical treatment.

Lithiasic complications of renal transplantation: The donor graft lithiasis concept

Lithiasis is usually a late complication of renal transplantation reported in approximately 1% of all renal allografts. Underlying predisposing conditions for the formation of calculi are present in almost all cases. Preexisting stones in the donor kidney have been reported once previously. The authors have observed 2 such cases, detected by routine sonography. In 1 case, stone migration into the ureter led to acute postoperative transplant failure; this complication has never been reported previously.

Complications of mesh repair in hiatal surgery: about 3 cases and review of the literature.

Primary repair of large hiatal hernia is associated with high recurrence rate. The use of prosthetic mesh to reinforce the cure seems to lead to less recurrence. Unfortunately, this procedure is still controversial in regard of the possible complications that may occur. We report here 3 cases of complications related to mesh placement in hiatal hernia surgery: an esophageal perforation, an intragastric migration, and a fundic erosion. When a patient complains of epigastric pain or dysphagia with no peritoneal signs, in the postoperative course of mesh placement, an upper endoscopy should be achieved to rule out those complications. The patient must be informed about the mesh placement and he must notify the endoscopist in case of an upper gastrointestinal endoscopy.

Anorectal stenosis in patients with prolonged use of suppositories containing paracetamol and acetylsalicylic acid

We report five cases in which anorectal stenosis was associated with chronic administration of suppositories containing paracetamol and acetylsalicylic acid. All patients were females taking suppositories for chronic migraine. Patients experienced anal pain, tenesmus, fecal incontinence, and, in two cases, intestinal obstruction. Lesions were characterized by a severe circular narrowing of the distal rectum with superficial ulcerations. Radiographs demonstrated the presence of sinus-tract-like formations in the diseased segment and thickening of the rectal wall. Histologic examination showed signs of chronic inflammation with deep ulcerations associated with obliteration of the lamina propria by a fibromuscular proliferation, as was described in the solitary ulcer syndrome of the rectum. Rectal administration of suppositories was discontinued in all the patients. Two patients were improved by anorectal dilatation, but the remaining three required a left proctocolectomy with subsequent coloanal anastomosis. The use of such suppositories must be restricted.

Case report: Colour Doppler demonstration of pseudoaneurysms complicating pancreatic pseudocysts

The great morbidity and mortality associated with pseudoaneurysms complicating pancreatic pseudocysts stress the need for their early detection. The authors report the use of colour Doppler sonography in the detection of pseudoaneurysms within pancreatic pseudocysts, emphasizing not only the value of this modality in the initial diagnosis, but also its value in monitoring the success of transcatheter embolization. Colour Doppler should be used systematically in the evaluation of pancreatic pseudocysts.

Splenic epithelial cyst mistaken with Hydatid cyst: A case report

Highlights • Cystic lesions of the spleen are rare pathology with epithelial cyst being the most common type.• The radiologic imaging may be commonly misleading and non-conclusive and the definitive diagnosis is made on histopathology.• Splenic epithelial cyst should be kept in the differential diagnosis of a splenic cyst along with hydatid disease.• Surgical treatment is indicated for symptomatic cysts or those larger than 5 cm.

A primary peritoneal pseudomyxoma peritonei arising from the mullerian tissue: A case report

Abstract A primary Pseudomyxoma Peritonei is uncommon. For a long time, ovaries, colon and appendix were proposed like a site origin of these enigmatic lesions. Recent publications show that the majority of cases are due to a rupture of appendicle adenoma. We report a case of a pseudomyxoma peritonei arising in an elderly patient with a previous medical history of appendectomy undergone in infancy. The pseudomyxoma was misdiagnosed as an abdominal abscess related to colitis. In our opinion, metaplasia of the Müllerian system is a possible source of a primary peritoneal pseudomyxoma.

Dual phase helical CT of a primary malignant fibrous histiocytoma of the right renal vein.

A case is reported of primary malignant fibrous histiocytoma of the right renal vein involving the ipsilateral kidney which showed early enhancement on dual phase helical CT. The correct diagnosis of a primary tumour of the renal vein involving the kidney was not made but in retrospect could have been achieved pre-operatively by considering several CT features.