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In male elite gymnastics, lately, eccentric training is often used to improve the maximum specific strength of static elements on rings. Therefore, in this study, we aimed to investigate the effects of a three-week, gymnastic-specific, eccentric-isokinetic (0.1 m/s) cluster training with a change of stimulus after three of six training sessions (eccentric-isokinetic with additional load) on a computer-controlled training device on the improvement of the elements swallow and support scale on rings. Maximum strength and strength endurance in maintaining the static positions of ten international elite male gymnasts were determined on a weekly basis. After three weeks of training, specific maximum strength and strength endurance increased significantly (strength: swallow: +8.72%, p < 0.001; support scale: 8.32%, p < 0.0001; strength endurance: swallow: +122.36%; p = 0.02; Support Scale: +93.30%; p = 0.03). Consequently, top gymnasts can considerably improve ring-specific strength and strength endurance in only three weeks. The separate analysis of the effects of both eccentric-isokinetic training modalities showed that efficiency might even be increased in future training interventions. We suggest using this type of training in phases in which the technical training load is low and monitoring the adaptations in order to compile an individually optimized training after an intervention.

Single access endoscopic surgery, also called laparoendoscopic single site surgery, single port access or single incision laparoscopic surgery has rapidly emerged in clinical practice for some specific indications. Among them single access cholecystectomy is rapidly diffusing in an attempt to improve cosmetic results, reduce parietal trauma, fasten recovery and answer patient's demand of this frequent surgery. While this approach is diffusing some limitations still persist in its feasibility, which have to be overcome by new development in instrumentations and refinement in techniques. And, on the other hand safety principle of minimally invasive cholecystectomy should be strictly respected to ensure our patients safe surgeries. Recent experiences and reports have shown that all these points can be respected, at least by experienced teams, while offering patients the first steps towards routine clinical scarless surgery. In this paper we will review the current status of cholecystectomy through single access endoscopic surgery regarding techniques, indications and results.

Positron Emission Tomography (PET) using (18)F-fluorodeoxyglucose (FDG) associated with computed tomography (CT) is increasingly used for the detection and the staging of pancreatic cancer, but data regarding its clinical added value in pre-surgical planning is still lacking. The aim of this study is to investigate the performance of FDG PET associated with contrast-enhanced CT in detection of pancreatic cancer.

Surgical innovations (associating LESS, NOTES, robotics, images software and Fast-track surgery) will allow a less and less invasive surgery. While these advances could be view as surgical or industrial marketing, or compared to the laparoscopic revolution, they simply answer patients' demand in a society changing its standard regarding: medical care, body image, recovery and rehabilitation. We will in this paper, according to results of a Google Survey analyzing population expectations of surgery, evaluate the interest of these surgical innovations. While, these innovations at least in part answers patients expectation, their therapeutic validity will have to be proved. It is our job, to foresee the future of surgery in accordance with health care system needs and patients expectation for adequate implementation of these innovations.

Laparoendoscopic Single-Site Surgery (LESS) has made its fore ways into clinical practice, and allows foreseeing a less traumatic surgery without visible scar. Its development reminds the revolution associated with apparition of laparoscopy. Actual clinical experience gained showed that LESS is valid, seems as safe as conventional laparoscopy, while offering patients a surgery without trace. LESS development, which requires advanced laparoscopy training, has made surgeons and industry rethink surgical ergonomic thus allowing rapid technical innovations. These innovations will change minimally invasive surgery in a near future, if they did not already. We, now, have to control its evolution to build a safe and reasonable future for minimally invasive surgery combining patients' desire and safety, populations needs.

Senior population (> or = 70 y) represents approximately 17% of Western population and account for 2/3 of all solids cancers of which > 50% are colorectal. Their treatment would request major abdominal surgery, often not offered because of senior age or fear of prohibitive morbidity. Fast-track programs reduce postoperative morbidity and hospital stay after elective colorectal surgery. According to few studies, this approach seems to be safe and feasible in senior patients. In our institution, mortality/morbidity rates were 0% and 37% after elective colorectal surgery in senior patients with standard care, with a median hospital stay of 13 days. Elective colorectal surgery should be offered to senior patients. However the relative high morbidity rate with standard care prompts us to initiate a specifically designed fast-track protocol in senior patients.

Gastrointestinal stromal tumors (GIST) are the most common digestive mesenchymal tumors. GIST characterized by over-expression of the tyrosine kinase receptor KIT. GIST span a wide clinical spectrum from benign to highly malignant. Surgery is the only curative treatment for GIST. Low malignant GIST have an excellent prognosis after surgical treatment (5 years survival rate > 90%). Highly malignant GIST have an extremely poor prognosis even after surgical resection (median survival < 12 months). The development of tyrosine kinase inhibitors has changed the management of unresectable GIST. One of them, imatinib mesylate, has been proved to improve survival of metastatic GIST. This paper reviews literature data on GIST.

Natural orifice translumenal endoscopic surgery (NOTES) is an exciting concept bringing scarless surgery a reality consisting in body cavity and organs approach through natural orifices (digestive, female genital, urinary tracts). While new instrumentation necessitated by NOTES is still developing, multiple surgical procedures have been performed with success in human. Whenever this approach combining surgical and endoscopic expertise needs technical improvement and clinical validation, it will have a large impact on the future of surgery related to population demand for scarless surgery. The next decade, will show us if surgery will be performed through NOTES or if minimally invasive surgery will be positively influenced by the technical progress of NOTES to be the most minimally traumatic.

Elective colectomies are standard procedures carrying below 1% mortality; by contrast, emergency colonic resections remain surgical challenges in compromised and/or elderly patients and are associated with high complication rates.

Duodenal adenocarcinomas are uncommon tumors characterized by non-specific symptoms and late diagnosis. The objective of this study was to assess long-term results of locally advanced duodenal adenocarcinoma treated by surgical resection.A retrospective study, over a 10-year period, identified 9 patients (mean age 65 years) treated for duodenal carcinoma.Out of nine patients who were treated for duodenal adenocarcinoma, 8 underwent R0 resection (5 pancreaticoduodenectomies, 1 total pancreaticoduodenectomy and 2 segmental duodenal resections). All of them had tumor of stage II or III according to TNM classification. Median follow-up was 104 months (range 25 to 185). Five patients had lymph node metastases (stage III) at the time of surgery. Two- and five-year survival rates were 100% and 75%, respectively for the whole group. No correlation between lymph node status and survival was found.Radical surgical resection for locally advanced duodenal adenocarcinomas provides good long-term results in terms of patient survival, even for N1 tumors (stage III).

Currently, the number of patients awaiting transplantation is continuously increasing, and shortage of available deceased organ donors is the major limitation for organ and cell allotransplantation. Research to develop alternative sources of tissues is ongoing and xenogeneic organs or cells represent an attractive solution. This review focuses on recent progress achieved in this field, including the development of newly genetically modified animal donors and new immunosuppressive approaches. As xenotransplantation is moving closer to clinical application, future perspectives must establish guidelines to ensure that future clinical trials are carried out ethically and safely.

Diabetes is one of the most common chronic diseases in our society. While insulin treatment for diabetes type I could delay and reduce the incidence of diabetic complications, it is associated with an increased risk of severe hypoglycemia. To restore physiologic insulin metabolism, transplantation of insulin producing cells (pancreatic Beta cells) represent the sole available therapy. It could be done either through pancreas or islet of Langerhans transplantation. In this paper, we review actual knowledge regarding these two types of transplantations.

Gastrointestinal stromal tumours (GIST) are the most common mesenchymal tumours of the digestive tract. Most gastrointestinal soft tissue neoplasms, previously classified as leiomyomas, schwannomas, leiomyoblastomas or leiomyosarcomas, are today classified as GIST on the basis of molecular and immunohistological features. They originate from gastrointestinal pacemaker cells and are characterised by over-expression of the tyrosine kinase receptor KIT. Overall 5-year survival after surgical resection of GIST is approximately 60%. However, these tumours span a wide clinical spectrum from benign to highly malignant. Prognostic factors have recently been identified for GIST and include tumour size, mitotic rate and other minor factors. At present, surgery is the standard treatment for primary resectable GIST. Benign GIST have an excellent prognosis after primary surgical treatment, with over 90% 5-year survival. While recurrent or malignant GIST, which are resistant to radiotherapy and chemotherapy, had until recently an extremely poor prognosis even after surgical resection, with median survival of 12 months. The development of a tyrosine kinase inhibitor has changed the management of unresectable malignant cases. This new tyrosine kinase inhibitor, imatinib mesylate, which inhibits the c-kit receptor, has proved highly effective against GIST and has improved survival in metastatic GIST. This paper reviews the literature and our experience of GIST, including: diagnosis, pathology, treatment and prognosis.

An up-to-date synthesis of pancreatic islet allotransplantation is included in this summary, with emphasis on new developments and clinical results of the field. Rationale for islet transplantation in type 1 diabetes mellitus, current patient selection criteria, clinical data, technical aspects of organ procurement, islet isolation and transplantation are highlighted. The current challenges are also presented and analysed. Significant advances in clinical islet transplantation have been achieved recently. New immunosuppressive strategies were introduced, there were considerable changes in the patient selection criteria. International collaborations were established in order to standardize islet isolation and transplantation procedures. The spectacular results, recently reported by the Edmonton-group, represent a major breakthrough of the field and the outcomes are comparable with the results of whole pancreas transplantation. Islet transplantation became one of the most promising fields of tolerance induction research. Although still considered experimental, within the frameworks of expanding international collaborations, pancreatic islet allotransplantation gains more and more recognition in the clinical practice. These elements give hope that diabetes might be in the near future treated by islet cell transplantation.

Embryological and physiological data suggest that proximal (in relation to the splenic flexure) and distal parts of the colon represent distinct anatomical and functional entities. Since 1990, molecular biologists have identified two distinct pathways, microsatellite instability (MSI) and chromosomal instability (CIN), which are involved in the pathogenesis of colon cancer (CC). Thus, a new paradigm has emerged with the discovery that CC is a heterogeneous disease; furthermore recent data have demonstrated that these two distinct pathways in colorectal carcinogenesis are characterized by a different clinical outcome. The implications for the clinicians are twofold; (1) tumors originating from the proximal colon have a better prognosis due to a high percentage of MSI-positive lesions; and (2) location of the neoplasm in reference to the splenic flexure should be documented before group stratification in ongoing trials of adjuvant chemotherapy for CC. In the future, clinical decision-making regarding adjuvant chemotherapy might be stratified according to the MSI status of cancers located proximally to the splenic flexure.