Intermittent selective clamping improves rat liver regeneration by attenuating oxidative and endoplasmic reticulum stress.

Intermittent clamping of the portal trial is an effective method to avoid excessive blood loss during hepatic resection, but this procedure may cause ischemic damage to liver. Intermittent selective clamping of the lobes to be resected may represent a good alternative as it exposes the remnant liver only to the reperfusion stress. We compared the effect of intermittent total or selective clamping on hepatocellular injury and liver regeneration. Entire hepatic lobes or only lobes to be resected were subjected twice to 10 min of ischemia followed by 5 min of reperfusion before hepatectomy. We provided evidence that the effect of intermittent clamping can be damaging or beneficial depending to its mode of application. Although transaminase levels were similar in all groups, intermittent total clamping impaired liver regeneration and increased apoptosis. In contrast, intermittent selective clamping improved liver protein secretion and hepatocyte proliferation when compared with standard hepatectomy. This beneficial effect was linked to better adenosine-5'-triphosphate (ATP) recovery, nitric oxide production, antioxidant activities and endoplasmic reticulum adaptation leading to limit mitochondrial damage and apoptosis. Interestingly, transient and early chaperone inductions resulted in a controlled activation of the unfolded protein response concomitantly to endothelial nitric oxide synthase, extracellular signal-regulated kinase-1/2 (ERK1/2) and p38 MAPK activation that favors liver regeneration. Endoplasmic reticulum stress is a central target through which intermittent selective clamping exerts its cytoprotective effect and improves liver regeneration. This procedure could be applied as a powerful protective modality in the field of living donor liver transplantation and liver surgery.

[Vaginal hemangioma revealed by bleeding in a girl: a case report]. / Hémangiome vaginal révélé par un saignement chez une petite fille: à propos de 1 cas.

We report on the case of a 9-year-old girl who presented vaginal bleeding which led to the diagnosis of vaginal hemangioma. Such localisation is rare, and requires a clinical follow-up by vaginoscopy. A spontaneous regression can be expected but, at this time, the progress of puberty and future fertility are unknown.

[What education means in surgery? A surgery among chirurgical residents in university hospital in Strasbourg]. / Quels moyens de formation en chirurgie ? A propos d'une enquête aux hôpitaux universitaires de Strasbourg auprès des internes en chirurgie.

OBJECTIVE: Numerous tools for surgical education are available. The objective of the study is to know how future surgeons do feel about these different possibilities to learn and what do they think about the place of e-learning, or virtual universities and on-line training and learning in their formation. METHODS: A questionnaire has been sent to each surgical student of Strasbourg University. Learning and training methods were evaluated: observation, fellowship, Internet, reading videos, reading books or scientific journals, discovery of pathology by oneself or performing surgical procedures by oneself, sharing meetings, playing pedagogic games. RESULTS: Fellowship is voted by plebiscite, as using Internet which grows the usual book contents thanks to interactivity, videos, quickenings and actuality of the inquiries. The difficulties to approach this tool is emphasized : the cost, availability, time consuming, lack of any tutor, ability with a computer. Dissection of corpses or live animals is wished by the majority of young surgeons. Using simulators or robots remains something for the future and must be evaluated. CONCLUSION: Fellowship is voted by plebiscite for learning surgery. The interest for new technologies of communication is more out of curiosity than necessity.

Effectiveness of detergent-disinfecting agents on Escherichia coli 54127 biofilm.

Detergent-disinfecting agents (dD) are used daily for cleaning reused medical devices. We have devised a simple method to test dD detergent activity (DA) using an E. coli 54127 biofilm prepared in haemolysis glass tubes, which are cleaned with test dD, according to supplier's recommendations. Crystal violet 0.05% is used to colour the residual biofilm after dD (or tap water control) application. The biofilm quantification was made indirectly by measuring the absorbance of crystal violet at 585 nm. A measure of the detergent effectiveness called DA was calculated as the percentage reduction of colour from a tap water control. Fifteen products including enzymatic and non-enzymatic dDs were evaluated. Most enzymatic dDs gave a high DA, as did some non-enzymatic products. Thus, the view that enzymatic dDs are more effective than non-enzymatic dDs, put forward by some manufacturers, should be regarded with caution. The DA determination should help infection control teams choose, within the wide range of products available on the market, the most effective dD based on both its detergent and disinfecting activity.

A continuous series of 96 laparoscopic inguinal hernia repairs in children by a new technique.

BACKGROUND: The aim of this study was evaluate a novel technique of laparoscopic hernia repair in children. METHODS: Eighty two consecutive patients aged >or=2 years old were operated on for hernia repair using a laparoscopic technique that reproduced every step of the conventional open procedure. Technical details and clinical results are reported. RESULTS: Ninety six sacs were divided in 82 patients (15 girls and 67 boys). Fourteen bilateral hernias that had been diagnosed before operation in nine cases and during laparoscopy in five cases were repaired. Nine controplateral dimples were left and not repaired. Mean operative time was 23 min in girls and 28 min in boys for unilateral hernias, and 30 min in girls and 40 min in boys for bilateral hernias. Sixty-seven of the children were followed up 6 months later. None of them suffered recurrences. No unsightly scars were observed at the port sites. Discomfort did not extend beyond 48 h after the operation, enabling a rapid return to normal activities. CONCLUSION: Dividing the sac and suturing the peritoneum is feasible and efficient by laparoscopy. Compared with the other techniques that have previously been reported, either without any dissection of the sac or any ligature, our technique seems to be advantageous. It is not time consuming and does not require any special laparoscopic skill.