Gastrectomie longitudinale calibrée ou sleeve gastrectomie : expérience abidjanaise

Introduction : Le but de ce travail a été d'évaluer et d'analyser les 29 premiers cas de sleeve gastrectomie à Abidjan. Patients et Méthodes : Nous avons évalué le dossier des patients opérés pour obésité morbide dans 03 cliniques privées d'Abidjan par l'équipe du Pr N'Guessan Alexandre de 2009 à 2014. Ont été inclus tous les patients ayant bénéficié d'une sleeve gastrectomie laparoscopique pour obésité morbide. Résultats : 29 patients ont été opérés ; 28 femmes et 1 homme avec un âge moyen de 34 ans. L'indice de masse corporelle (BMI) compris entre 35 et 49 Kg/m2 avec des comorbidités. La procédure laparoscopique a été possible dans tous les cas sans conversion. La durée opératoire moyenne était de 3h. Les patients étaient exéat dans 70% des cas au 2ème jour post opératoire après un contrôle au bleu de méthylène. Quatre (4) complications (1 abcès sous phrénique, 1 occlusion du grêle, 1 sténose gastrique et 1 fistule digestive) ont nécessité une reprise opératoire. La mortalité opératoire était de 6.89%. environ 92,85% des patients avaient une perte d'excès de poids supérieure à 50% sur 4 ans, avec une amélioration des comorbidités. Conclusion : La sleeve gastrectomie est une technique réalisable dans nos conditions de travail. Elle nécessite une bonne sélection des patients, une équipe multidisciplinaire

Multi Target Neuroprotective and Neurorestorative Anti-Parkinson and Anti-Alzheimer Drugs Ladostigil and M30 Derived from Rasagiline

Present anti-PD and -AD drugs have limited symptomatic activity and devoid of neuroprotective and neurorestorative property that is needed for disease modifying action. The complex pathology of PD and AD led us to develop several multi-target neuroprotective and neurorestorative drugs with several CNS targets with the ability for possible disease modifying activity. Employing the pharmacophore of our anti-parkinson drug rasagiline (Azilect, N-propagrgyl-1-R-aminoindan), we have developed a series of novel multi-functional neuroprotective drugs (A) [TV-3326 (N-propargyl-3R-aminoindan-5yl)-ethyl methylcarbamate)], with both cholinesterase-butyrylesterase and brain selective monoamine-oxidase (MAO) A/B inhibitory activities and (B) the iron chelator-radical scavenging-brain selective monoamine oxidase (MAO) A/B inhibitor and M30 possessing the neuroprotective and neurorescuing propargyl moiety of rasagiline, as potential treatment of AD, DLB and PD with dementia. Another series of multi-target drugs (M30, HLA-20 series) which are brain permeable iron chelators and potent selective brain MAO inhibitors were also developed. These series of drugs have the ability of regulating and processing amyloid precursor protein (APP) since APP and alpha-synuclein are metaloproteins (iron-regulated proteins), with an iron responsive element 5"UTR mRNA similar to transferring and ferritin. Ladostigil inhibits brain acetyl and butyrylcholinesterase in rats after oral doses. After chronic but not acute treatment, it inhibits MAO-A and -B in the brain. Ladostigil acts like an anti-depressant in the forced swim test in rats, indicating a potential for anti-depressant activity. Ladostigil prevents the destruction of nigrostriatal neurons induced by infusion of neurotoxin MPTP in mice. The propargylamine moiety of ladostigil confers neuroprotective activity against cytotoxicity induced by ischemia and peroxynitrite in cultured neuronal cells. The multi-target iron chelator M30 has all the properties of ladostigil and similar neuroprotective activity to ladostigil, but is not a ChE inhibitor. M30 has a neurorestorative activity in post-lesion of nigrostriatal dopamine neurons in MPTP, lacatcystin and 6-hydroxydopamine animal models of PD. The neurorestorative activity is related to the ability of the drug to activate hypoxia inducing factor (HIF) which induces the production of such neurotrophins as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and erythropoietin as well as glia-derived neurotrophic factor (GDNF). The unique multiple actions of ladostigil and M30 make the potentially useful drugs for the treatment of dementia with Parkinsonian-like symptoms and depression.

Promise of Neurorestoration and Mitochondrial Biogenesis in Parkinson's Disease with Multi Target Drugs: An Alternative to Stem Cell Therapy

There is an unmet need in progressive neurodegenerative diseases such as Parkinson's and Alzheimer's diseases. The present therapeutics for these diseases at best is symptomatic and is not able to delay disease or possess disease modifying activity. Thus an approach to drug design should be made to slow or halt progressive course of a neurological disorder by interfering with a disease-specific pathogenetic process. This would entail the ability of the drug to protect neurons by blocking the common pathway for neuronal injury and cell death and the ability to promote regeneration of neurons and restoration of neuronal function. We have now developed a number of multi target drugs which possess neuroprotective, and neurorestorative activity as well as being able to active PGC-1alpha (peroxisome proliferator-activated receptor gamma coactivator-1alpha), SIRT1 (NAD-dependent deacetylase protein) and NTF (mitochondrial transcription factor) that are intimately associated with mitochondrial biogenesis.

Why Do We Need Multifunctional Neuroprotective and Neurorestorative Drugs for Parkinson's and Alzheimer's Diseases as Disease Modifying Agents

Parkinson's disease (PD) and Alzheimer's Disease (AD) are severe neurodegenerative disorders, with no drugs that are currently approved to prevent the neuronal cell loss characteristic in brains of patients suffering from PD and AD and all drug treatment are synptomactic. Due to the complex pathophysiology, including a cascade of neurotoxic molecular events that results in neuronal death and predisposition to depression and eventual dementia and etiology of these disorders, an innovative approach towards neuroprotection or neurorestoration (neurorescue) may be the development and use of multifunctional pharmaceuticals. Such drugs target an array of pathological pathways, each of which is believed to contribute to the cascades that ultimately lead to neuronal cell death. In this short review, we discuss examples of novel multifunctional ligands that may have potential as neuroprotective-neurorestorative therapeutics in PD and AD. The compounds discussed originate from synthetic chemistry as well as from natural sources.

Maladie de Crohn: premiere description en Cote-d'Ivoire

The authors rep o rt the fi rst case of Crohn's disease in Cote-d'Ivo i re. A 20-ye a r-old Ivo rian man presented chronicdiarrhea and weight loss over six ye a rs. Ulcerated lesions we re found throughout the colon extending to the terminal ilieum but not involving the rectum. Diagnosis of Crohn's disease was established on ra d i o l ogical and histological findings. Treatmentconsisted of total colectomy with ileorectal anastomosis. This case is of special interest because of the extremely low incidence of Crohn's disease in black Africa

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant en Afrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)

Bilan de quatre annees de chirurgie laparoscopique a Abidjan

La chirurgie laparoscopique fait partie integrante de l'arsenal therapeutique en chirurgie digestive. Les auteurs font le bilan de quatre annees d'experience a propos de 494 patients operes par cette methode a Abidjan; Cote d'Ivoire. Si les indications essentielles sont representees par les cholecystectomies et les appendicectomies; le champ d'application de la coeliochirurgie est interessant enAfrique Noire tant en chirurgie reglee (exploration laparoscopique des douleurs abdominales chroniques et des cancers digestifs) qu'en chirurgie d'urgence (peritonite; contusion abdominale)