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Biomedical subjects

D Bernard

Publications and source records attributed to D Bernard.

At least 127 records · Page 7Linked to original sources
PubMed1988

[Malignant colonic polyps: is polypectomy adequate treatment?].

The management of patients with endoscopically removed malignant intestinal polyps is controversial. The risk of residual disease should be assessed against the risk of a surgical operation. The authors report 35 cases of malignant polyps (5.5% of 641 colonoscopically removed adenomas). Sixteen patients had carcinoma in situ and received no further treatment and 19 had invasive carcinoma (sessile in 6, pedunculated in 13). Of these 19, 7 did not undergo surgery--because of old age in 2, minimal invasion in 3, a low rectal location in 1 and refusal in 1. Twelve patients (3 with sessile, 9 with pedunculated polyps) underwent a surgical resection, and residual disease was present in 3 (25%), 1 with positive nodes. Reported criteria of increased risk of residual disease--cancer in lymphatics or veins, incomplete excision, tumour at resection margin, sessile and villous tumours--were present in nine. All three patients with residual disease had microscopically involved margins of resection. The authors believe that the increased risk of recurrence justifies the risk associated with subsequent surgical resection unless the patient is otherwise a poor operative risk.

Adenoma↗
PubMed1987

[Experimental autoimmune encephalomyelitis: immunoregulation and genetic control].

EAE is a good model of autoimmune diseases and an approximate one of MS, particularly in its chronic recurrent and demyelinating forms. The antigenic target of EAE has recently been better defined: in different species, as well as within a given one, the encephalitogenic determinant, target of T effector cells, is located in different parts of the basic protein of myelin. The recognition of the relevant epitope is influenced by the genotype of the antigen presenting cells. By analogy, in MS, one can expect to find various target-antigens for the immune (autoimmune?) reactions that occur in the Central Nervous System of different patients, may be in correlation with HLA phenotype. The study of immunoregulatory processes in EAE suggests a possible role for suppressor cells and for variations in the capacity of interleukin-2 production. Similarly, in MS, variations in suppressor cell activities have been found in acute attacks. Finally, the possibility of "vaccinating" against EAE with attenuated encephalitogenic line cells, opens new interesting perspectives in the therapy of MS.

Animals↗
PubMed1987

Should cholecystectomy be done en passant for asymptomatic cholelithiasis?

The management of asymptomatic gallstones discovered during abdominal surgery is controversial. Should cholecystectomy be performed en passant? The authors report a 4-year survey of 109 patients with asymptomatic cholelithiasis who underwent surgery for other abdominal conditions: colorectal (31), gastric (24), vascular (20), gynecologic (21) and miscellaneous (13). Cholelithiasis was established preoperatively by ultrasonography in 52 of 55 examinations (95%). In the other 54, the gallstones were discovered at operation. Cholecystectomy was performed in 78 patients and in 31 the gallbladder was left in place. In the former group, 11 (14%) had complications, 2 being attributable to the cholecystectomy. Intraoperative cholangiograms were obtained in 43 and led to common-bile-duct explorations in 8. Common-bile-duct stones were found in seven. In the non-cholecystectomized group, three died postoperatively and three were lost to follow-up. Twelve of the remaining 25 are still asymptomatic and 13 have had symptoms: 7 underwent cholecystectomy (4 for acute cholecystitis) between 2 weeks and 11 months after the initial laparotomy. Because of the low morbidity and the relatively high number of cholecystectomies that were subsequently necessary, the authors recommend cholecystectomy en passant unless there is a specific contraindication. They also recommend ultrasonography before major gastrointestinal or vascular surgery in order to plan for cholecystectomy.

Adult↗
PubMed1987

Is preoperative colonoscopy in carcinoma a realistic and valuable proposition?

Colonoscopy was performed preoperatively in 100 consecutive patients as a prospective study to establish the feasibility of the procedure and its value, which was considered "adequate" when the colon remaining after surgical resection had also been examined preoperatively. Colonoscopy was adequate in 35 of 46 patients (76%) with malignant tumour located in the cecum and ascending and transverse colon, but in only 15 of 54 patients (28%) who had a tumour in the left colon or rectum. Synchronous malignant tumours were present in 2 patients, and 54 additional adenomas were discovered in 29 patients. These adenomas could be removed endoscopically in 13 patients and were included in the standard resection in 12. Extension of the planned operation was necessary in only four patients with synchronous adenomas. Routine preoperative colonoscopy to assess the presence of synchronous colonic tumours is more likely to be adequate in proximal or right-sided large-bowel tumours than in left-sided tumours because of the annular configuration of the latter. Because of the high rate (46%) of synchronous adenomas in adequate examinations, inadequate preoperative colonoscopy should be complemented by a repeat examination 3 to 6 months postoperatively in every patient with a malignant tumour of the large bowel.

Adenoma↗
PubMed1986

Toxic megacolon. An analysis of 70 cases.

The clinical features and outcome of 70 patients treated for toxic megacolon between 1970 and 1984 in five university-affiliated hospitals were determined. There were 35 women and 35 men with a mean age of 39 +/- 0.2 years. Toxic megacolon occurred at the initial episode of colitis in 43 patients (61 percent). Only five patients had a specific colitis: salmonellosis, two; ischemic, two; and pseudomembranous, one. Of the 65 remaining patients with nonspecific colitis, six had to be operated on without delay because of peritonitis. In the remaining 59 patients, toxic megacolon was cured with intensive medical management in nine (15 percent), improved temporarily in 14 (24 percent), and remained unchanged in 36 (61 percent). The postoperative mortality rate was 11 percent for all patients (6/56), 4 percent for patients without perforation (2/50) compared with 27 percent for patients with perforation (4/15). None of the patients who underwent surgery within five days of medical treatment died. When toxic megacolon was complicated by hemorrhage (nine patients) or peritonitis (eight patients), the mortality rate increased to 33 percent and 27 percent, respectively. A one-stage proctocolectomy was performed in 19 patients (32 percent). Of 32 patients in whom the rectum was retained, successful restoration of continuity was possible in only seven (22 percent) within 12 months after surgery. In well-selected patients, a plea is made for rectal preservation to offer an alternative to permanent ileostomy.

Adolescent↗
PubMed1986

Experimental autoimmune encephalomyelitis mediated by T lymphocyte lines: genotype of antigen-presenting cells influences immunodominant epitope of basic protein.

Lewis rats are susceptible to experimental autoimmune encephalomyelitis (EAE), and their T lymphocytes recognize epitopes in the 68-88 sequence of guinea pig myelin basic protein (BP). BN rats are resistant to EAE, and their T lymphocytes recognize epitopes outside of the 68-88 sequence, probably in the 43-67 portion of BP. To investigate the influence of the genome of antigen-presenting cells (APC) on the dominance of BP epitopes for T lymphocyte lines, we selected anti-BP lines from (Lewis X BN)F1 rats by using the APC of Lewis, BN, or F1 origin. We now report that the F1/Lewis and F1/F1 lines recognized the 68-88 epitopes and were highly encephalitogenic in F1 rats, whereas the F1/BN line recognized the 43-67 epitopes and was only weakly encephalitogenic. Thus, the genotype of the APC can influence the immunologic dominance for T lymphocytes of BP epitopes, and this dominance in turn can influence the expression of disease.

Animals↗
PubMed1986

Colonoscopic assessment of radiologic strictures of the colon.

The authors studied 47 patients with radiologic evidence of stricture to determine whether colonoscopy in this situation increased the accuracy of diagnosis and how this procedure might influence patient management. Colonoscopy increased to 81% the diagnostic accuracy, which was established at 38% with the single-contrast enema. Failure of both techniques to establish a precise diagnosis was 19%. From the clinical and radiologic data, surgical exploration for the 47 strictures would have been necessary in 28, not indicated in 9, and indicated solely for diagnostic purposes in 10. The addition of colonoscopy prevented unnecessary laparotomy in 5 (18%) of the first group and in 8 (80%) of the last. The authors conclude that colonoscopy should be complementary to the standard radiologic examination for colonic strictures, especially when carcinoma is suspected or if roentgenography does not provide a definitive diagnosis.

Adult↗
PubMed1986

Selective surgical management of Crohn's disease of the anus.

To establish specific indications for the surgical treatment of perianal Crohn's disease, the authors report their experience with 102 patients (45%) with these lesions in a series of 225 patients with small- and large-bowel Crohn's disease. Ulcerations or fissures were present in 50%, abscesses developed in 32% and fistulas in 53%. More than one type of lesion was present in 59%. One of six patients had no symptoms, in one of five the lesion was etiologically independent of Crohn's disease and one of four patients did not require surgical intervention. Severe pain indicated an abscess that required drainage, and 57% of patients who underwent drainage alone or with an added seton later required fistulotomy to become symptom-free. Primary fistulotomy for abscess achieved complete healing in 71% of cases and fistulotomy also healed in 60% of chronic fistulas for a combined fistulotomy healing rate of 63% when anal Crohn's disease was present and 68% in all patients with Crohn's disease. Anal dilatations with bougies were effective in short stenoses which were present in 7% of cases. Twelve percent of patients required excision of the rectum to be relieved of their symptoms.

Abscess↗
PubMed1985

IgG purification to measure the level of an iodinated thyroglobulin peptide, the 3,5,3',5' tetraiodo-l-tyrosyl-l-tyrosine in human serum.

Antibodies reacting with 3,5,3',5' tetraiodo-l-tyrosyl-l-tyrosine (I2Tyr-I2Tyr) were elicited in rabbits by immunization with an oxidized yeast conjugate coupled with I2Tyr-I2Tyr. Ion-exchange chromatography was used to purify immunoglobulins, in order to improve the specificity in measurement of I2Tyr-I2Tyr level in patient serum. IgG binding capacity versus I2Tyr-I2Tyr was considerably increased after immunoglobulin purification.

Animals↗
PubMed1985

beta-Thromboglobulin in patients with breast cancer.

beta-Thromboglobulin (beta TG) plasma levels were determined in 52 female breast cancer patients at different stages and in 39 healthy controls (22 women and 17 men) of similar age distribution. Beta TG levels were high (mean +/- SD:61.6 +/- 59.1 ng/ml) in patients before any treatment compared to controls (mean +/- SD:21.2 +/- 7.4 ng/ml) and the difference was statistically significant (p less than 0.001). No correlation with disease stage was observed. No other coagulation parameters were abnormal except fibrinogen, which increased. Fibrinogen degradation products (FDP) also increased but only in metastatic patients. Chemotherapy appeared to induce a considerable decrease in initial values at the end of the first cycle without modifying the platelet count. In addition, an attempt was made to correlate the beta TG plasma level investigated serially for several months with disease evolution.

Adult↗
PubMed1984

Genetic analysis of cerebellar lipids in mice susceptible to audiogenic seizures.

The major neutral and acidic cerebellar lipids were studied in audiogenic seizure (AGS)-resistant C57BL/6 (B6) and AGS-susceptible DBA/2J (D2) mice. These cerebellar lipids were also studied in the D2.B6- Iasb congenic mice and in the B6D2F1 hybrids that are mostly AGS resistant. Except for the Iasb gene, which inhibits AGS susceptibility, the D2.B6- Iasb congenic mice are genetically similar to the D2 mice. Because subtle abnormalities in the chemical structure of membranes may underlie epilepsy, we wanted to determine if AGS susceptibility was associated with abnormalities in the distribution of cerebellar lipids. A new method for the analysis of total brain lipids was used in this study. Slight, but significant, differences were found between the B6 and D2 strains for the concentrations (microgram/100 mg wet weight) of sphingomyelin, phosphatidylcholine, and cerebrosides. However, these differences may not be associated with differences in AGS susceptibility since the concentrations of these lipids in the AGS-resistant D2.B6- Iasb and B6D2F1 mice were more similar to the D2 than the B6 concentrations. The expression of Iasb is not responsible for the lipid differences found between the B6 and D2 mice.

Acoustic Stimulation↗
PubMed1984

Presence of HLA-D/DR antigens on the membrane of breast tumour cells.

HLA-D/DR (Ia) glycoproteins were identified in human breast carcinoma and normal mammary gland cells by means of an anti-Ia monoclonal antibody. Two techniques were used: (1) immunoperoxidase staining performed on histological sections and (2) Ia glycoproteins were isolated as follows: firstly by radioactive labelling of isolated cells, then by filtration on Sephadex G25, followed by Lens culinaris chromatography, and immune complex formation and then elution on protein A-Sepharose. Lastly, the immune complex was studied by chromatofocusing. Both techniques revealed that Ia expression was found in carcinoma cells, but not in normal cells.

Adenofibroma↗