Rétablissement de continuité après gastrectomie : quelle technique ?
ABSTRACT Different techniques of reconstruction are offered after gastrectomy. The preferred reconstruction should allow maintaining nutritional status and quality of life of patients at the price of the lowest postoperative morbidity. The aim of this study was to describe the different techniques of reconstruction after distal and total gastrectomy, reminding the French guidelines on the use of mechanical sutures in these indications. We then conducted a review of randomized trials dealing with techniques of reconstruction after distal and total gastrectomy. After distal gastrectomy, Roux-en-Y reconstruction seems superior to Billroth I and Billroth II reconstruction in terms of functional outcomes and long-term endoscopic results and should be chosen in patients with benign disease or surperficial tumours. Otherwise, Billroth II reconstruction should be preferred to Billroth I reconstruction for preventing postoperative morbidity and in order to preserve oncological margins. After total gastrectomy, Roux-en-Y reconstruction remains the easiest solution, with satisfactory functional results. Addition of a pouch reservoir after Roux-en-Y reconstruction seems to improve functional short-term results after total gastrectomy with greater intake. In the long-term, it could be beneficial from the quality of life standpoint mainly in cases of small resected tumours associated with a good prognosis.
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ABSTRACT: Improved expression of recombinant laccase by Pichia pastoris carrying the lcc1 cDNA isolated from Trametes versicolor was achieved by optimization of the cultivation conditions in a fermentor equipped with a methanol sensor system. The results indicated that the activity obtained in fermentor cultivations was at least 7 times higher than in shake-flask cultures. Three different strategies for fermentor cultivations were compared: A (30 degrees C, 1.0% methanol), B (20 degrees C, 1.0% methanol), and C (20 degrees C, 0.5% methanol). The laccase activity, particularly the specific activity, could be improved by decreasing the cultivation temperature. The mechanisms behind the temperature effect on the laccase activity may be ascribed to poor stability, release of more proteases from dead cells, and folding problems at higher temperature. The results showed that the methanol concentration had a marked effect on the production of active heterologous laccase. A fivefold higher volumetric laccase activity was obtained when the methanol concentration was kept at 0.5% instead of 1.0%. The detrimental effect of methanol on the production of recombinant laccase may be attributed to lower laccase stability, a higher proteolytic activity, and folding problems due to higher growth rate at 1.0% methanol.Biotechnology and Bioengineering 09/2002; 79(4):438-449. · 4.16 Impact Factor
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ABSTRACT: Advanced Oxidation Processes (O3, O3/H2O2, UV, UV/O3, UV/H2O2, O3/UV/H2O2, Fe2+ /H2O2 and photocatalysis) for degradation of phenol in aqueous solution have been studied in earlier works. In this paper, a comparison of these techniques is undertaken: pH influence, kinetic constants, stoichiometric coefficient and optimum oxidant/pollutant ratio. Of the tested processes, Fenton reagent was found to the fastest one for phenol degradation. However, lower costs were obtained with ozonation. In the ozone combinations, the best results were achieved with single ozonation. As for the UV processes, UV/H2O2 showed the highest degradation rate.Water Research 03/2002; 36(4):1034-42. · 4.66 Impact Factor