Patrice Forget

Publications (26) View all

• Article: Insights into fast-track colon surgery: a plea for a tailored program.

  L Pellegrino, F Lois, C Remue, P Forget, B Crispin, D Leonard, J Jamart, A Kartheuser
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  ABSTRACT: BACKGROUND: This retrospective study compared the fast-track colon surgery program to conventional perioperative care and assessed factors that influence postoperative length of stay. DESIGN: This retrospective study included 124 fast-track and 119 conventional care colon surgical patients. Exclusion criteria were primary rectal disease, stoma, American Society of Anesthesiologists score IV, and Association Française de Chirurgie index 3 or 4. Laparoscopy was the preferred approach. Variables influencing length of stay were analyzed by multivariate linear and logistic regression. RESULTS: Overall mortality and complication rates were not significantly different between groups (fast-track vs. controls 0 vs. 0.8 %, 30.6 vs. 38.6 % respectively). As expected, median length of stay was significantly reduced in fast-track patients (3 vs. 6 days, p < 0.001), but emergency readmission rate was higher (16.9 vs. 7.6 %, p = 0.026), although rehospitalization rates were similar (8 vs. 4.2 %, not significant). Independent risk factors of increased length of stay were identified as age >69 years (p = 0.001), laparotomy (p = 0.011), and conventional perioperative care (p < 0.001). CONCLUSIONS: The introduction of a fast-track program reduced postoperative length of stay without increasing complication rate. This study proposes a modulation of the program according to patient age and surgical approach.
  Surgical Endoscopy 10/2012; · 4.01 Impact Factor
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  Available from: Patrice Forget

  Article: In vivo optical spectroscopy monitoring in a new model of muscular compartment syndrome.

  P Forget, F Ponchon, M Vanhoonacker, G G Stoquart, T M Lejeune, F Lois, D Kahn, J L Schils, M De Kock
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  ABSTRACT: /st> Muscular compartment syndrome (MCS) is a rare but serious postoperative complication. In vivo optical spectroscopy (INVOS) monitors continuously and non-invasively regional oxygen saturation (rSO(2)), and could predict the development of MCS. /st> In 10 healthy volunteers, we inflated a tourniquet to the mean arterial pressure to produce slight venous congestion and arterial hypoperfusion. Comparisons were made between the relative reduction in rSO(2) with baseline (deltaINVOS) and the time to observe motor nerve block (with non-invasive electromyography). Neurological symptoms, pain, and invasive intracompartmental pressure (ICP) were assessed. /st> In the eight volunteers completing the protocol, we observed a profound motor nerve conduction block, immediately reversible. Baseline values were: [mean (sd)] INVOS: 73.3 (8.9)% and ICP: 16.9 (8.6) mm Hg. At the time of the block, values were: INVOS: 46.4 (10.9)%, deltaINVOS: 28.7 (10.6)%, and ICP: 70.0 (5.5) mm Hg. The time to reach the block was 33.0 (10.9) min, and to a deltaINVOS>10%: 27.4 (10.4) min. Receiver-operating characteristic curves demonstrated a similar accuracy of ICP and INVOS to predict the occurrence of the block. Twenty minutes with a deltaINVOS>10% or ICP>30 mm Hg were associated with a sensitivity and a specificity of 95% and 70%; or 91% and 65%, respectively. /st> We have developed a model of acute immediately reversible MCS. Monitoring using the INVOS technology is as accurate as measurement of ICP, and could be a useful tool to prevent development of intraoperative MCS.
  BJA British Journal of Anaesthesia 07/2012; 109(4):561-5. · 4.24 Impact Factor
• Article: Vitamin D deficiency in a cohort of HIV-infected patients: clinical analysis.

  D Wilmes, P Forget, A Vincent, L Belkhir, S Jonckheere, B Vandercam, J Yombi
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  ABSTRACT: Purpose of the study: Observational studies have noted very high rates of low serum 25-hydroxyvitamin D [25(OH)D3] levels in both general and HIV-infected populations. In HIV-infected patients, low 25(OH)D3 levels are secondary to a combination of usual risk factors and HIV-specific risk factors, like antiretroviral therapy [1]. The objective of our study is to analyse the magnitude of vitamin D deficiency or insufficiency and the role of various factors such as age, sex, ethnicity, season, and antiretroviral medications in our cohort of HIV-infected patients. Methods: We prospectively collected data on 25-hydroxyvitamin D levels sampled between January 2009 and June 2011 from our cohort of 930 HIV-infected patients. Vitamin D dosage was performed using immunoassay ('Diasorin' - Saluggia, Italy). We divided vitamin D levels into 3 categories: 25-hydroxyvitamin D levels <20 mg/nl were considered deficient, insufficient between 20 and 29 ng/ml. Levels ≥30 ng/ml were defined as normal [2]. Data on demographic features (age, ethnicity, season, heterosexuality vs homosexuality), clinical features and laboratory findings (CD4 cell count, viral load, HAART, BMI) were collected from patients' medical records using our institutional database 'Medical explorer v3r9, 2009'. Summary of results: Overall, 848 patients were included in our study (Table 1). Low levels of serum 25(OH)D3 were seen in 89.3% of the study population, from which 69.5% were deficient and 19.8% were insufficient. On univariate analysis, female sex, high BMI, black African, heterosexuality, undetectable viral load and antiretroviral treatment were all predictors of vitamin D deficiency and insufficiency. Treatment with efavirenz and tenofovir were the most associated with low vitamin D levels. On multivariate analysis (multiple linear regression model) only female sex (OR=1.14; 95% CI 0.84-0.96; p<0.001), dosage during winter months (OR=1.14; 95% CI 1-1.15; p<0.05) and HAART (OR=1.12; 95% CI 1.04-1.19; p=0.002) were identified as independent risk factors of low 25(OH)D3 levels. Conclusion: Vitamin D deficiency is frequent in HIV-infected populations (69.5%). Patients on antiretroviral therapy are at higher risk of vitamin D deficiency. In our cohort, black women and dosage during winter were also independent risk factors for low vitamin D levels.
  Journal of the International AIDS Society 01/2012; 15(6):18205. · 3.26 Impact Factor
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  Available from: Patrice Forget

  Article: Promising development from translational or perhaps anti-translational research in breast cancer

  MW Retsky, R Demicheli, WJM Hrushesky, P Forget, M De Kock, RA Rogers, M Baum, K Pachmann, JS Vaidya
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  ABSTRACT: Background A great deal of the public’s money has been spent on cancer research but demonstrable benefits to patients have not been proportionate. We are a group of scientists and physicians who several decades ago were confronted with bimodal relapse patterns among early stage breast cancer patients who were treated by mastectomy. Since the bimodal pattern was not explainable with the then well-accepted continuous growth model, we proposed that metastatic disease was mostly inactive before surgery but was driven into growth somehow by surgery. Most relapses in breast cancer would fall into the surgery-induced growth category thus it was highly important to understand the ramifications of this process and how it may be curtailed. With this hypothesis, we have been able to explain a wide variety of clinical observations including why mammography is less effective for women age 40–49 than it is for women age 50–59, why adjuvant chemotherapy is most effective for premenopausal women with positive lymph nodes, and why there is a racial disparity in outcome. Methods We have been diligently looking for new clinical or laboratory information that could provide a connection or correlation between the bimodal relapse pattern and some clinical factor or interventional action and perhaps lead us towards methods to prevent surgery-initiated tumor activity. Results A recent development occurred when a retrospective study appeared in an anesthesiology journal that suggested the perioperative NSAID analgesic ketorolac seems to reduce early relapses following mastectomy. Collaborating with these anesthesiologists to understand this effect, we independently re-examined and updated their data and, in search of a mechanism, focused in on the transient systemic inflammation that follows surgery to remove a primary tumor. We have arrived at several possible explanations ranging from mechanical to biological that suggest the relapses avoided in the early years do not show up later. Conclusions We present the possibility that a nontoxic and low cost intervention could prevent early relapses. It may be that preventing systemic inflammation post surgery will prevent early relapses. This could be controlled by the surgical anesthesiologist’s choice of analgesic drugs. This development needs to be confirmed in a randomized controlled clinical trial and we have identified triple negative breast cancer as the ideal subset with which to test this. If successful, this would be relatively easy to implement in developing as well as developed countries and would be an important translational result.
  Clinical and Translational Medicine. 01/2012; 1(17).
• Article: Prevention of chronic postoperative pain: Cellular, molecular, and clinical insights for mechanism-based treatment approaches.

  Ronald Deumens, Arnaud Steyaert, Patrice Forget, Michael Schubert, Patricia Lavand'homme, Emmanuel Hermans, Marc De Kock
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  ABSTRACT: Nearly every surgery can elicit a rather therapy-resistant chronic postoperative pain. Preventive medicine is therefore anticipated with hopeful eyes, but requires a better understanding of the neurobiological mechanisms underlying the transition from acute to chronic pain. Spinal mechanisms of pain amplification are regarded as fundamental to pain chronification, but these mechanisms on their own are not at all likely to be sufficient. Indeed, not every surgical patient develops chronic postoperative pain. Progress in our neurobiological understanding of postoperative pain includes scientific discoveries of 'vulnerability factors', which substantially impact on the spinal cord, augmenting pain amplification mechanisms, perhaps to levels of no-return. In this review we elaborate on spinal pain amplification mechanisms in relation to pain chronification and the impact of vulnerability factors hereon. Moreover, these insights are incorporated within a clinical frame of treatment approaches currently used in surgical settings. As such, this review provides an integrated overview of mechanism-based treatment approaches in prevention of chronic postoperative pain.
  Progress in Neurobiology 02/2013; · 8.87 Impact Factor