LA RADIOTHÉRAPIE DANS LE CANCER DU RECTUM CHEZ LA PERSONNE ÂGÉE: Quel bénéfice pour le traitement ?
MARTINIVE, Philippe ; ALLEPAERTS, Sophie ; VAN DAELE, Daniel et al
in Revue Médicale de Liège (2014), 69(Supp 1), 47-52
Dans les années à venir, nous serons de plus en plus amenés à prendre en charge des patients âgés en oncologie. Dans ce contexte, quelles sont les évidences scientifiques à notre disposition qui nous ... [more ▼]
Dans les années à venir, nous serons de plus en plus amenés à prendre en charge des patients âgés en oncologie. Dans ce contexte, quelles sont les évidences scientifiques à notre disposition qui nous permettent de prendre en charge de façon correcte cette population oncologique âgée ? Les patients âgés présentent souvent de multiples co-morbidités pouvant interférer avec le traitement oncologique rendant d’autant plus complexe leur prise en charge. Le pic d’inci - dence du cancer du rectum se situe autour des 80 ans, loin au-dessus de l’âge moyen des patients inclus dans les études cliniques. La survie globale des patients traités pour un cancer du rectum s’est améliorée au cours de la dernière décennie, essentiellement pour des patients de moins de 75 ans. Le trai - tement du cancer du rectum nécessite une approche multidis - ciplinaire. L’évaluation gériatrique en fait partie intégrante. Elle permet de définir au mieux la stratégie thérapeutique en fonction de l’état général du patient, de son contexte neuro- psychologique, fonctionnel et social. La radiothérapie joue un rôle majeur dans le traitement du rectum. Quelle est sa place chez les personnes âgées ? Bénéficient-elles également de la radiothérapie, comme la population jeune sélectionnée dans les études contrôlées ? Quel est l’impact de ce traitement sur la qualité de vie ? Voilà des questions essentielles auxquelles nous allons tenter d’apporter une réponse [less ▲]Detailed reference viewed: 25 (2 ULg)
LA RADIOTHÉRAPIE DANS LE CANCER DU RECTUM : quand, comment et pourquoi ?
MARTINIVE, Philippe ; VAN DAELE, Daniel ; LENNERTS, Evelyne et al
in Revue Médicale de Liège (2014), 69(Supp 1), 37-46
Depuis plusieurs décades, la radiothérapie préopéra - toire ou postopératoire joue un rôle important dans le contrôle local de l’adénocarcinome du rectum. Cette dernière décennie, avec la systématisation ... [more ▼]
Depuis plusieurs décades, la radiothérapie préopéra - toire ou postopératoire joue un rôle important dans le contrôle local de l’adénocarcinome du rectum. Cette dernière décennie, avec la systématisation de la chirurgie d’exérèse en totalité du mésorectum (TME), le profil de récidive locale du cancer du rectum a été fortement modifié. Dans un tel contexte, la place de la radiothérapie doit être réévaluée en tenant compte de ces modifications. Dans cet article, nous proposons de faire la revue des différentes grandes études concernant les techniques et les indications d’un traitement de radiothérapie pré- ou post opératoire dans le contexte d’une chirurgie rectale TME. [less ▲]Detailed reference viewed: 49 (11 ULg)
IS ULTRA-SHORT COLD ISCHEMIA THE KEY TO ISCHEMIC CHOLANGIOPATHY AVOIDANCE IN DCD- LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Transplant International (2013, December), 26(S2), 53-98
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic ... [more ▼]
Introduction: Donation after circulatory death (DCD) donors have been proposed to partially overcome the organ donor shortage. DCD-LT remains controversial, with reported increased risk of ischemic cholangiopathy leading to graft loss. The authors retrospectively reviewed a single centre experience with DCD-LT in a 9-year period. Patients and Methods: 70 DCD-LT were performed from 2003 to November 2012. All DCD procedures were performed in operative rooms. Median donor age was 59 years. Most grafts were flushed with HTK solution. Allocation was centre-based. Median total DCD warm ischemia was 19.5 min. Mean follow-up was 36 months. No patient was lost to follow-up. Results: Median MELD score at LT was 15. Median cold ischemia was 235 min. Median peak AST was 1,162 U/L. Median peak bilirubin was 31.2 mg/dL. Patient and graft survivals were 92.8% and 91.3% at one year and 79% and 77.7% at 3 years, respectively. One graft was lost due to hepatic artery thrombosis. No PNF or graft loss due to ischemic cholangiopathy was observed in this series. Causes of death were malignancies in 8 cases. Discussion: In this series, DCD LT appears to provide results equal to classical LT. Short cold ischemia and recipient selection with low MELD score may be the keys to good results in DCD LT, in terms of graft survival and avoidance of ischemic cholangiopathy. [less ▲]Detailed reference viewed: 25 (5 ULg)
Obesity phenotype is related to NLRP3 inflammasome activity and immunological profile of visceral adipose tissue
ESSER, Nathalie ; L'Homme, Laurent ; DE ROOVER, Arnaud et al
in Diabetologia (2013), 56
Aims/hypothesis Obesity is a heterogeneous condition comprising both individuals who remain metabolically healthy (MHO) and those who develop metabolic disorders (metabolically unhealthy, MUO). Adipose ... [more ▼]
Aims/hypothesis Obesity is a heterogeneous condition comprising both individuals who remain metabolically healthy (MHO) and those who develop metabolic disorders (metabolically unhealthy, MUO). Adipose tissue is also heterogeneous in that its visceral component is more frequently associated with metabolic dysfunction than its subcutaneous component. The development of metabolic disorders is partly mediated by the NLR family pyrin domain containing-3 (NLRP3) inflammasome, which increases the secretion of inflammatory cytokines via activation of caspase-1. We compared the immunological profile and NLRP3 activity in adipose tissue between MUO and MHO individuals. Methods MHO and MUO phenotypes were defined, respectively, as the absence and the presence of the metabolic syndrome. Cellular composition and intrinsic inflammasome activity were investigated by flow cytometry, quantitative RTPCR and tissue culture studies in subcutaneous and visceral adipose tissue from 23 MUO, 21 MHO and nine lean individuals. Results We found significant differences between the three study groups, including an increased secretion of IL-1β, increased expression of IL1B and NLRP3, increased number of adipose tissue macrophages and decreased number of regulatory T cells in the visceral adipose tissue of MUO patients compared with MHO and lean participants. In macrophages derived from visceral adipose tissue, both caspase-1 activity and IL-1β levels were higher in MUO patients than in MHO patients. Furthermore, caspase-1 activity was higher in CD11c+CD206+ adipose tissue macrophages than in CD11c−CD206+ cells. Conclusions/interpretation The MUO phenotype seems to be associated with an increased activation of the NLPR3 inflammasome in macrophages infiltrating visceral adipose tissue, and a less favourable inflammatory profile compared with the MHO phenotype. [less ▲]Detailed reference viewed: 45 (12 ULg)
Increased Inflammasome and Caspase-1 Activation in Visceral adipose tissue from Metabolically Unhealthy Obese compared to Metabolically Healthy Obese subjects
Esser, Nathalie ; L'Homme, Laurent ; DE ROOVER, Arnaud et al
in Diabetes (2013, July), (62/suppl.1), 555Detailed reference viewed: 42 (12 ULg)
Is ultra-short cold ischemia the key to ischemic cholangiopathy avoidance in DCD-LT?
DETRY, Olivier ; DE ROOVER, Arnaud ; et al
in Acta Chirurgica Belgica (2013, May), Supplement 113(3), 6729Detailed reference viewed: 43 (12 ULg)
Différences d’activité de l’inflammasome NLRP3 entre sujets obèses avec et sans anomalies métaboliques
Esser, Nathalie ; L'Homme, Laurent ; DE ROOVER, Arnaud et al
in Diabètes & Métabolism (2013, March), 39(suppl 1), 102Detailed reference viewed: 43 (14 ULg)
Laparoscopic repair of colonoscopic perforation: a new standard?
Coimbra Marques, Carla ; Bouffioux, Laurent ; Kohnen, Laurent et al
in Surgical Endoscopy (2011), 25
BACKGROUND: Scientific evidence demonstrating interest in the laparoscopic approach for surgical repair of colonoscopic perforations is still lacking. The authors retrospectively reviewed the records of ... [more ▼]
BACKGROUND: Scientific evidence demonstrating interest in the laparoscopic approach for surgical repair of colonoscopic perforations is still lacking. The authors retrospectively reviewed the records of 43 patients who suffered from colonic perforations after colonoscopy between 1989 and 2008 in two tertiary centers in order to compare the results of the laparoscopic and the open approaches to repair. METHODS: The patients' demographic data, perforation location, therapy, and outcome were recorded from the medical charts. Forty-two patients were managed operatively (19 laparoscopies and 23 laparotomies). In three patients who underwent explorative laparoscopy, the procedure had to be converted to laparotomy due to surgical difficulties. The patients who underwent laparotomy management had a longer period between the colonoscopy and the surgery (P = 0.056) and more stercoral contaminations. RESULTS: The mean hospital stay was shorter for the laparoscopy group (P = 0.02), which had fewer postoperative complications (P = 0.01) and no mortality (NS). CONCLUSION: This series demonstrates that early laparoscopic management of colonoscopic perforation is safe. Laparoscopic management may lead to reduced surgical and psychological stress for the patient because of its low morbidity and mortality rates and shorter hospital stay. However, the procedure should be converted to a laparotomy if necessary. [less ▲]Detailed reference viewed: 105 (9 ULg)
Contribution of donors after cardiac death to the deceased donor pool: 2002 to 2009 university of liege experience.
; Meurisse, Nicolas ; Delbouille, Michèle et al
in Transplantation Proceedings (2010), 42(10), 4369-72
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine ... [more ▼]
OBJECTIVE: In this study, we have evaluated the organ procurement and transplantation activity from donors after cardiac death (DCD) at our institution over an 8-year period. Our aim was to determine whether this program influenced transplantation programs, or donation after brain death (DBD) activity. METHODS: We prospectively collected our procurement and transplantation statistics in a database for retrospective review. RESULTS: We observed an increasing trend in potential and actual DCD number. The mean conversion rate turning potential into effective donors was 58.1%. DCD accounted for 16.6% of the deceased donor (DD) pool over 8 years. The mean age for effective DCD donors was 53.9 years (range, 3-79). Among the effective donors, 63.3% (n = 31) came from the transplant center and 36.7% (n = 18) were referred from collaborative hospitals. All donors were Maastricht III category. The number of kidney and liver transplants using DCD sources tended to increase. DCD kidney transplants represented 10.8% of the DD kidney pool and DCD liver transplants made up 13.9% of the DD liver pool over 8 years. The DBD program activity increased in the same time period. In 2009, 17 DCD and 33 DBD procurements were performed in a region with a little >1 million inhabitants. CONCLUSION: The establishment of a DCD program in our institution enlarged the donor pool and did not compromise the development of the DBD program. In our experience, DCD are a valuable source for abdominal organ transplantation. [less ▲]Detailed reference viewed: 37 (15 ULg)
Natural orifice transluminal endoscopic surgery (NOTES): when a step forward may be a step too soon or too far.
Detry, Olivier ; ; Kohnen, Laurent
in Surgical Endoscopy (2010), 2010(24), 1213-1214Detailed reference viewed: 89 (16 ULg)
Scarless cholecystectomy: laparoscopic surgery by unique umbilical incision
Kohnen, Laurent ; Coimbra Marques, Carla ; De Roover, Arnaud et al
in Revue Médicale de Liège (2010), 65(10), 543-4Detailed reference viewed: 54 (3 ULg)
Surgical management of hepatic metastases of colorectal origin.
; Honore, Charles ; Detry, Olivier et al
in Acta Gastro-Enterologica Belgica (2009), 72(3), 321-6
Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronously or ... [more ▼]
Colorectal cancer is the most frequent digestive cancer. Prognosis is greatly depending on the TNM stage at the time of diagnosis. Fifty percent of all patients shall develop, synchronously or metachronously, liver metastases. Different means such as chemotherapy, targeted therapies, radiofrequency ablation, portal vein embolization and two-stage hepatectomy may be used to make these metastases eventually resectable and to increase overall survival. This is a short review of these different methods used to increase resectability but also on the integration of these parameters in a larger approach of colorectal liver metastasis surgery especially insisting on multidisciplinary discussion. [less ▲]Detailed reference viewed: 101 (6 ULg)
Liver Transplantation Is Feasible in Super-Obese Patients: A Case Report.
Detry, Olivier ; Seydel, Benoît ; Kohnen, Laurent et al
in Transplantation Proceedings (2009), 41(8), 3430-3431
Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be ... [more ▼]
Short- and long-term results of liver transplantation in morbidly obese patients may be impaired compared with the general transplant population. As a consequence, severe obesity has been considered to be a relative contraindication to liver transplantation in many centers. Surgically, liver transplantation in severe obesity may be challenging. Moreover, obesity may lead to an increased rate of early and late medical complications. Herein we have reported successful liver transplantation in a super-obese patient (body mass index, 55.1 kg/m(2)) who had developed terminal acute-on-chronic liver disease. In the first 6 months of follow-up, the patient underwent a severe diet that led to a significant weight loss reduction to a body mass index of 39 kg/m(2). This report of successful liver transplantation in a super-obese patient suggests that severe obesity should not be considered to be an absolute contraindication to liver transplantation. [less ▲]Detailed reference viewed: 50 (12 ULg)