Long-term Outcome of a Fissurectomy: A Prospective Single-Arm Study of 50 Operations out of 349 Initial Patients

Jean-David Zeitoun,Pierre Blanchard,Nadia Fathallah,Paul Benfredj,Nicolas Lemarchand,Vincent de Parades 대한대장항문학회 2018 Annals of Coloproctolgy Vol.34 No.2

Purpose: The surgical standard of care for patients with chronic anal fissure is still disputed. We aimed to assess the natural course of idiopathic anal fissure and the long-term outcome of a fissurectomy as a surgical treatment. Methods: All consecutive patients referred to a single expert practitioner in a tertiary centre were primarily included. A fissurectomy was proposed in cases of refractory symptoms after 4 to 6 weeks of standard medical management. Only patients with idiopathic and noninfected anal fissures were included in this second subsample to undergo surgery. Conventional postoperative management was prescribed for all patients who had undergone surgery. The main outcome measures were the success rate (defined as a combination of wound healing and relief of pain) and postoperative anal continence. Results: Three hundred forty-nine patients were primarily recruited. Fifty patients finally underwent surgery for an idiopathic and noninfected fissure. Among them, 47 (94%) were cured at the end of primary follow-up, and 44 of the 47 (93.6%) could be confirmed as being sustainably cured in the longer-term follow-up. The mean time of complete healing was 10.3 weeks (range, 5.7–36.4 weeks). All patients were free of pain at weeks 42. The continence score after surgery was not statistically different from the preoperative score. Conclusion: A fissurectomy for the treatment of patients with an idiopathic noninfected fissure is associated with rapid pain relief and a high success rate even though complete healing may often be delayed. Moreover, it appears to have no adverse effect on continence.

Frequency and risk factors of severe postoperative bleeding after proctological surgery: a retrospective case-control study

Taieb Sarah,Atienza Patrick,Zeitoun Jean-David,Taouk Milad,Bourguignon Josée,Thomas Christian,Rabahi Nabila,Dahlouk Saliha,Lesage Anne-Carole,Lobo David,Etienney Isabelle 대한대장항문학회 2022 Annals of Coloproctolgy Vol.38 No.5

Purpose: The aim of this study was to assess frequency and risk factors of severe bleeding after proctological surgery requiring hemostatic surgery observed after publication of the French guidelines for anticoagulant and platelet-inhibitor treatment. Methods: All patients who underwent proctological surgery between January 2012 and March 2017 in a referral center were included. Delay, severity of bleeding, and need for blood transfusion were recorded. Patients with severe postoperative bleeding were matched to controls at a 2:1 ratio adjusted on the operator, and the type of surgery. Results: Among the 8,890 operated patients, 65 (0.7%) needed a postoperative hemostatic procedure in an operating room. The risk of a hemostatic surgery was significantly increased after hemorrhoidal surgery compared with other procedures (1.9% vs. 0.5%, P<10–4) and was most frequent after Milligan-Morgan hemorrhoidectomy (2.5%). Mean bleeding time was 6.2 days and no bleeding occurred after day 15. Blood transfusion rate was 0.1%. Treatment with anticoagulants and platelet inhibitors were managed according to recommendations and did not increase the severity of bleeding. The risk of severe bleeding was significantly lower in active smokers vs. non-smokers in univariate (16.9% vs. 36.2%, P=0.007) and multivariate (odds ratio, 0.31; 95% confidence interval, 0.14–0.65) analysis whereas sex, age, and body mass were not significantly associated with bleeding. Conclusion: Severe postoperative bleeding occurs in 0.7% of patients, but varies with type of procedure and is not affected by anticoagulant or antiplatelet treatment. These treatments given in accordance with the new guidelines do not increase the severity of postoperative bleeding.

The Therapeutic Potential of Amniotic Fluid-Derived Stem Cells on Busulfan-Induced Azoospermia in Adult Rats

Ibrahim Heba F.,Safwat Safinaz H.,Zeitoun Teshreen M.,El Mulla Khaled F.,Medwar Amira Y. 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.2

BACKGROUND: Busulfan is an alkylating chemotherapeutic agent that is routinely prescribed for leukemic patients to induce myelo-ablation. However, it also results in azoospermia and infertility in cancer survivors. This research was constructed to explore the possible therapeutic role of amniotic fluid-derived stem cells (AFSCs) in improving busulfan-induced azoospermia in adult rats. METHODS: Forty two adult male albino rats were randomized into: (1) control group, (2) azoospermia group, (3) spontaneous recovery group, and (4) AFSCs-treated group, in which AFSCs were transplanted through their injection into the testicular efferent ducts. The assessment included a histo-pathological examination of the seminiferous tubules by the light and transmission electron microscopes. Additionally, the confocal laser scanning microscope was used for confirmation of homing of the implanted cells. Moreover, we conducted an immuno-fluorescence study for detection of the proliferating cell nuclear antigen (PCNA) in the spermatogenic cells, epididymal sperm count, and a histo-morphometric study. RESULTS: AFSCs successfully homed over the basement membrane of the injured seminiferous tubules. They greatly attenuated busulfan-induced degenerative and oxidative changes. They also caused a re-expression of PCNA in the germ cells, leading to resumption of spermatogenesis and re-appearance of spermatozoa. CONCLUSION: AFSCs could be a promising treatment modality for male infertility induced by chemotherapy, as they possess prominent regenerative, anti-apoptotic, and anti-inflammatory potentials. BACKGROUND: Busulfan is an alkylating chemotherapeutic agent that is routinely prescribed for leukemic patients to induce myelo-ablation. However, it also results in azoospermia and infertility in cancer survivors. This research was constructed to explore the possible therapeutic role of amniotic fluid-derived stem cells (AFSCs) in improving busulfan-induced azoospermia in adult rats. METHODS: Forty two adult male albino rats were randomized into: (1) control group, (2) azoospermia group, (3) spontaneous recovery group, and (4) AFSCs-treated group, in which AFSCs were transplanted through their injection into the testicular efferent ducts. The assessment included a histo-pathological examination of the seminiferous tubules by the light and transmission electron microscopes. Additionally, the confocal laser scanning microscope was used for confirmation of homing of the implanted cells. Moreover, we conducted an immuno-fluorescence study for detection of the proliferating cell nuclear antigen (PCNA) in the spermatogenic cells, epididymal sperm count, and a histo-morphometric study. RESULTS: AFSCs successfully homed over the basement membrane of the injured seminiferous tubules. They greatly attenuated busulfan-induced degenerative and oxidative changes. They also caused a re-expression of PCNA in the germ cells, leading to resumption of spermatogenesis and re-appearance of spermatozoa. CONCLUSION: AFSCs could be a promising treatment modality for male infertility induced by chemotherapy, as they possess prominent regenerative, anti-apoptotic, and anti-inflammatory potentials.

Demonstration of a Circularly Polarized Plasma-Based Soft-X-Ray Laser

Depresseux, A.,Oliva, E.,Gautier, J.,Tissandier, F.,Lambert, G.,Vodungbo, B.,Goddet, J-P.,Tafzi, A.,Nejdl, J.,Kozlova, M.,Maynard, G.,Kim, H. T.,Phuoc, K. Ta,Rousse, A.,Zeitoun, P.,Sebban, S. American Physical Society 2015 Physical review letters Vol.115 No.8

Toward compact and ultra-intense laser-based soft x-ray lasers

Sebban, S,Depresseux, A,Oliva, E,Gautier, J,Tissandier, F,Nejdl, J,Kozlova, M,Maynard, G,Goddet, J P,Tafzi, A,Lifschitz, A,Kim, H T,Jacquemot, S,Rousseau, P,Zeitoun, P,Rousse, A IOP 2018 Plasma physics and controlled fusion Vol.60 No.1

<P>We report here recent work on an optical field ionized (OFI), high-order harmonic-seeded EUV laser. The amplifying medium is a plasma of nickel-like krypton obtained by OFI when focusing a 1 J, 30 fs, circularly-polarized, infrared pulse into a krypton-filled gas cell or krypton gas jet. The lasing transition is the 3d<SUP>9</SUP>4d (<I>J</I>?=?0)?→?3d<SUP>9</SUP>4p (<I>J</I>?=?1) transition of Ni-like krypton ions at 32.8 nm and is pumped by collisions with hot electrons. The gain dynamics was probed by seeding the amplifier with a high-order harmonic pulse at different delays. The gain duration monotonically decreased from 7 ps to an unprecedented shortness of 450 fs full width at half-maximum as the amplification peak rose from 150 to 1200 with an increase of the plasma density from 3?×?10<SUP>18</SUP> to 1.2?×?10<SUP>20</SUP> cm<SUP>−3</SUP>. The integrated energy of the EUV laser pulse was also measured, and found to be around 2 <I>μ</I>J. It is to be noted that in the ASE mode, longer amplifiers were achieved (up to 2 cm), yielding EUV outputs up to 14 <I>μ</I>J.</P>

Increased Long-term Risk of Anal Fistula After Proctologic Surgery: A Case-Control Study

Julie Assaraf,Elsa Lambrescak,Jeremie H Lefevre,Vincent de Parades,Josee Bourguignon,Isabelle Etienney,Milad Taouk,Patrick Atienza,Jean-David Zeitoun 대한대장항문학회 2021 Annals of Coloproctolgy Vol.37 No.2

Purpose Anal fistula is a common condition in proctology, usually requiring surgical treatment. Few risk factors have been clearly identified based on solid evidence. Our research objective was to determine whether history of anal surgery was a risk factor for subsequent anal fistula. Methods We conducted a case-control study from January 1, 2012 through December 31, 2013 in our tertiary center, comprising 280 cases that underwent surgery for anal fistula and 123 control patients seeking a consultation for upper gastrointestinal symptoms. Patients with inflammatory bowel disease were excluded. For both cases and controls, the following variables were recorded: sex, any prior anal surgery, diabetes mellitus, infection with human immunodeficiency virus, and smoking status. For each variable, confidence interval and odds ratio (OR) were calculated. Results In univariate analysis, male sex (73.2% vs. 31.7%, P < 0.0001), active smoking (38.1% vs. 22%, P = 0.0015), and prior anal surgery (16.0% vs. 4.1%, P = 0.0008) were associated with higher risk of anal fistula. In multivariate analysis, only male sex (OR, 5.5; 95% confidence interval [CI], 5.42 to 9.10; P < 0.0001) and previous anal surgery (OR, 4.48; 95% CI, 1.79 to 13.7; P = 0.0008) remained independently associated with anal fistula occurrence. Conclusion The epidemiology of anal fistula is poorly assessed despite the high frequency at which it is diagnosed. Our findings suggest that history of any kind of anal surgery is a risk factor for further onset of anal fistula. Surgeons and patients must be informed of this issue.