Serban Bageacu

Appendicectomy as a potential therapy for refractory ulcerative proctitis

SIRS, Treatment of refractory ulcerative proctitis (UP) is difficult. The majority of investigators have found a significant inverse relationship between appendicectomy and UP. It is also thought that the protective effect of appendicectomy depends on the inflammatory conditions (appendicitis or lymphadenitis) that were the indication for appendicectomy rather than on appendicectomy itself. Data regarding whether or not appendicectomy performed after the onset of UP can modulate its clinical course are still limited and conflicting, and properly controlled trials are needed. Despite this accumulating clinical evidence, the mechanism linking appendictis or appendicectomy and UP remains elusive. Bolin et al. reported a prospective case series of patients with ulcerative proctitis, who underwent appendicectomy in the absence of history suggestive of previous appendicitis; 90% of them improved their clinical activity index, with 40% experiencing remission by 12 months. Appendiceal histology in 29 cases demonstrated ulcerative appendicitis, but no patient had any evidence of typical acute appendicitis. We report a case series of eight patients (mean age 42.6 years, five men) who were treated for ulcerative proctitis, refractory to treatment with mesalazine (mesalamine) (2 g per day) orally and topically using elective appendicectomy. Characteristics of the eight patients before and after appendicectomy are reported in Table 1. No patient had symptoms of appendicitis, and rectal biopsies did not suggest cytomegalovirus infection. All patients had a Mayo score at endoscopy of 1 or more. All patients had mucosal healing of proctitis, with follow-up of 3.6 years. Four patients experienced only one moderate flare-up responding to topical therapy. There was no morbidity associated with appendicectomy. Four of the eight appendices removed were macroscopically normal. The remainder presented a macroscopic inflammatory appendix, without clinical symptoms. All patients had evidence of acute mucosal inflammation and a transmural neutrophilic infiltrate that are typical of acute appendicitis. Swidsinski et al. reported that local infection with Fusobacterium nucleatum or necrophorum are responsible for the majority of cases of acute appendicitis. These results could suggest a bacterial link between appendicitis and ulcerative colitis. Perhaps elective appendicetomy should be discussed with patients who suffer from refractory ulcerative colitis. Our findings provide rationale for controlled trials to properly evaluate the role of appendicectomy in the treatment of ulcerative colitis.

Comparison of adiponectin concentration between pancreatic cancer and colorectal cancer

INTRODUCTION Adiponectin (ADP) is an adipocytokine secreted by the adipose tissue which can be a useful marker in oncogenesis. Preliminary studies suggest that adiponectin rates differ according to the type of cancer. AIM OF STUDY Compare ADP plasma levels in pancreatic cancer (PC) and colorectal cancer (CRC) in a prospective monocentric study. PATIENTS AND METHODS The study included all the incident cases of PC gathered from a university hospital in France from January 2006 till September 2007. A control population of incident cases of colorectal cancer (CRC), matching on age, gender, and tumor staging was set in the same period. In addition to demographic data, the other parameters analyzed were: ADP rate, insulinoresistance (Homa-test), presence of a dysmetabolic syndrome, evolution of weight and data concerning the tumor (staging, tumor markers: ACE, CA19.9). RESULTS 33 CRC and 53 PC were analyzed. Type 2 diabetes was found in 18.2% of the CRC cases and 39.6% of the PC (p = 0.037). The mean ADP level was significantly higher in PC versus CRC (20.9 microgram/l versus 15.9 microgram/l; p = 0.03). In multivariate analysis , after adjusting for gender, age, bilirubinemia and weigth loss, the variables independently associated with a high level of ADP (> 10 microG/L) were type 2 diabetes (OR = 0.05, p = 0.01), insulinoresistance (OR = 0.42, p = 0.05) and PC (OR = 12.03, p = 0.047). CONCLUSION ADP concentration is higher in PC patients than in CRC patients. ADP concentration > 10 microgram/l was independently associated with pancreatic cancer. Our data confirm that adiponectin rates differ strongly according to the type of cancer.

Conduite à tenir devant un hématome rétro-péritonéal d'origine traumatique

Resume L’hematome retro-peritoneal (HRP) d’origine traumatique peut etre en rapport avec des lesions diverses : vasculaire, digestive, renale, osseuse. Pour schematiser sa prise en charge, on divise la region retro-peritoneale en trois zones. La zone I (centrale) s’etend depuis l’hiatus diaphragmatique de l’œsophage au promontoire sacre. La zone II (laterale) s’etend depuis le diaphragme jusqu’a l’aile iliaque. La zone III (pelvienne) correspond a la region sous-peritoneale pelvienne. Chez un traumatise presentant un HRP l’indication d’une exploration chirurgicale en urgence est posee sur l’instabilite hemodynamique malgre la reanimation intensive. L’indication operatoire est guidee egalement par le type du traumatisme (contusion ou plaie) et la localisation de l’HRP. De meme, l’ouverture d’un HRP decouvert au cours d’une laparotomie, pour lesion associe ou instabilite hemodynamique, obeit a la meme regle. L’exploration chirurgicale en urgence est indiquee systematiquement pour les HRP situes en region mediane sus-ombilicale (zone I) a la suite de traumatismes penetrants. Les indications des autres HRP doivent s’appuyer sur une analyse tomodensitometrique en urgence voire d’une arteriographie avec embolisation.