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Biomedical subjects

D Pezet

Publications and source records attributed to D Pezet.

At least 37 records · Page 2Linked to original sources
PubMed1998

Laparoscopic or open appendectomy? Critical review of randomized, controlled trials.

PURPOSE: A randomized, controlled trial is considered to be the "gold standard" to evaluate a new procedure. Thus, this critical review assessed whether the published randomized trials on laparoscopic appendectomy show that it is superior to the open approach. METHODS: Twelve original articles involving a randomized, controlled trial on laparoscopic appendectomy in adults published between January 1990 and December 1996 were selected. We studied first whether each trial was positive (a procedure is superior to the other) or negative (no difference). We reviewed for each trial the methodology used and the following outcomes: operating time, intraoperative and postoperative complications, time until resumption of diet, postoperative pain, hospital stay, cost, and quality of life analyses. Postoperative morbidity was considered as the major primary outcome. RESULTS: There were six positive and six negative trials. Postoperative complication rates were similar, but the two approaches had specific potential complications, wound infections following open appendectomy, and intra-abdominal abscesses following laparoscopic appendectomy. This review failed to show a superiority of the laparoscopy for the other outcomes, particularly postoperative pain. CONCLUSION: Differences in positive trials concerned subjective and controversial outcomes, and the flaw in negative trials was their lack of power. Thus, nothing is definitively well established, even after 12 randomized trials.

Appendectomy↗
PubMed1998

[Does neoadjuvant radiochemotherapy augment the resectability of pancreatic cancers?].

PURPOSE OF THE STUDY: Pre-operative radiochemotherapy is the most recent therapeutic option in the pre-operative downstaging of pancreatic cancer and in decreasing the rate of positive resection margins. The purpose of the study was to evaluate tolerance and efficacy of pre-operative radiochemotherapy in unresectable pancreatic cancers. MATERIAL AND METHODS: This study included seven cases of pancreatic cancer considered unresectable. The patients received preoperatively 50 grays within a 5-week period associated with 5 FU and Platin during the 1st and 5th weeks. RESULTS: After radiochemotherapy, tomodensitometric evaluation showed a minor response in two cases. A pancreatico-duodenectomy could be performed in these two patients without any increase of pre- or post-operative morbidity or mortality. CONCLUSIONS: The results of the study suggest that preoperative radiochemotherapy may increase pancreatic cancer resectability. This hypothesis should be confirmed by a prospective randomised trial.

Adenocarcinoma↗
PubMed1997

[Segmental absence of colonic muscularis propria. Report of a case in an adult].

We report a case of segmental defect of colonic muscularis propria revealed by perendoscopic perforation in a 64-year-old woman. Segmental absence of intestinal musculature is well documented in new-borns and infants and is more frequent in small bowel. It is characterized by localised absence of muscularis propria without fibrous scar. The remaining layers of the bowel wall are intact. The pathogenesis of this lesion is discussed.

Colon↗
PubMed1997

Analysis of randomized controlled trials in laparoscopic surgery.

BACKGROUND: Randomized controlled studies of surgical procedures are difficult, but can be done to acceptable standards. There are few published objective assessments of such trials. METHODS: The original articles that involved a randomized controlled trial including at least one laparoscopic procedure were reviewed and evaluated with special interest in their methodology. An assessment form containing 11 generic questions and three additional criteria (assessment of quality of life, cost analysis and laparoscopic experience required) was used. Forty trials were retrieved including 12 on cholecystectomy, 12 on hernia repair and 12 on appendicectomy. Each trial was scored by two assessors. RESULTS: The agreement among the two independent assessors was very good. Six of the trials were well conducted but 22 had a poor score. The trials on cholecystectomy were scored the best in contrast to those on hernia repair or appendicectomy. Few trials provided an adequate prospective calculation of the sample size, an unbiased assessment of endpoints, evaluation of the quality of life and a study of the economic aspects. CONCLUSION: Readers should be cautious when interpreting the results of some of these trials and their impact on daily surgical practice.

Humans↗
PubMed1997

[Peroperative manometric evaluation of posterior fundoplication by celioscopy].

The aim of this prospective study was to evaluate objectively the effects of a laparoscopic posterior fundoplication on the pressure and length of the lower oesophageal sphincter (LOS) and to compare these results to those of a group of patient who underwent the same technique through a laparotomy. Fourty six patients were included in the laparoscopic group and 48 in the open group. Intraoperative manometry was performed using the same material before and after the posterior fundoplication (after evacuating the pneumoperitoneum). Criteria of assessment were the increases in pressure and length of the LOS. The two groups were comparable regarding age, rate of hiatal hernia, and stage of the oesophagitis. In the laparoscopic group, the mean pressure of LOS (mmHg) increased from 10.1 +/- 3.8 to 35.2 +/- 12 after the fundoplication (that is 3.5 times) and the length of LOS (cm) increased from 3.4 +/- 0.8 to 4.8 +/- 0.8 (that is 1.4 times). In the open group the increase was for the pressure and length respectively 3.3 times and 1.5 times the initial values. Thus by performing the same procedure we obtained the same effects on the pressure and length of the LOS. The effectiveness of laparoscopic posterior fundoplication should be similar to that of the open procedure.

Adult↗
PubMed1997

Decreased folylpolyglutamate synthetase activity in tumors resistant to fluorouracil-folinic acid treatment: clinical data.

Thymidylate synthase (TS) is the main target for fluorouracil (FU). Optimal cellular concentrations of reduced folates in polyglutamated forms [via folylpolyglutamate synthetase (FPGS)] are necessary for achieving maximal TS inhibition. The aim of this multicentric prospective study was to analyze the link between clinical response to FU therapy for liver metastases of colorectal carcinoma and tumoral TS and FPGS activities. Forty-four advanced colorectal cancer patients (15 women and 29 men; median age 63, range, 27-78 years) receiving a standard FU-folinic acid protocol were included. A single hepatic tumoral biopsy was obtained systematically at the time of diagnosis. For 24 patients, a biopsy in the primary colon tumor was available. TS and FPGS activities were measured by radioenzymatic assays. Clinical response on hepatic metastases was 1 complete response, 12 partial responses, 14 stabilizations, and 17 progressions. In hepatic biopsies, TS activity (median, 185; range, <10-3111 fmol/min/mg protein) and FPGS activity (median, 1270; range, <400-3730 fmol/min/mg protein) exhibited a wide variability. TS activity in primary tumors (median, 461; range, 35-2565 fmol/min/mg protein) was significantly higher than in hepatic metastases. No difference was observed between primaries and metastases for FPGS. FPGS activity expressed in liver metastases was significantly correlated to that expressed in primaries. The distribution of TS activity in liver metastases was not significantly different between responsive and nonresponsive patients. However, FPGS activity measured in liver metastases was significantly higher in responsive patients (median, 1550 fmol/min/mg protein) than in nonresponsive patients (median, 1100 fmol/min/mg protein). A discriminant analysis revealed that 24 of the 25 patients exhibiting a liver FPGS activity </=1100 fmol/min/mg protein and/or a liver TS >320 fmol/min/mg protein were nonresponding patients. These data establish for the first time the potential importance of tumoral FPGS activity for assessing FU-folinic acid responsiveness in the clinical setting.

Adult↗
PubMed1996

[Antral exclusion. A complement to palliative gastrojejunal shunt in pancreatic cancer].

OBJECTIVES: Prophylactic gastrojejunostomy remains a controversial issue in the management of unresectable pancreatic cancer. The main disadvantage of the gastrojejunostomy being the postoperative delayed gastric emptying (gastroparesia and circulus vitiosus through the nonobstructed duodenum). In the aim to reduce the effects of delayed gastric emptying we advocated the adjunct of an antral exclusion to simplify antrectomy by eliminating antral dysfunction and duodenal circulus vitiosus. METHODS: The procedure of antral exclusion was performed using a 4-row linear stapler. The gastrojejunostomy was immediately proximal to the staples row. RESULTS: Preliminary results in 6 patients, evaluated by clinical follow up, radiologic and radionucleide studies, showed no delayed gastric emptying nor other postoperative complications related to this technique. CONCLUSION: These preliminary results are encouraging and suggest that this procedure could improve the functional results of the prophylactic gastrojejunostomy.

Anastomosis, Roux-en-Y↗
PubMed1996

[Non-surgical treatment of perforations of the thoracic esophagus].

OBJECTIVES: Thoracic oesophageal perforations are life-threatening conditions requiring immediate treatment. The type of treatment remains however controversial. The aim of this study was to evaluate the efficacy of the nonoperative management in this disease. METHODS: Six patients were admitted in our surgical unit for thoracic oesophageal perforations during the study period. One perforation was spontaneous (Boerhaave's syndrome). One had complicated an oesophageal ulcer. Two were secondary to caustic lesions. Two were secondary to instrumental dilations. The diagnostic and therapeutic delay was < or = 1 day in 5 cases. In one case the delay was 4 days but the mediastinitis was well tolerated. The treatment was based on antibiotics, nasoesophageal tube suction, and total parenteral nutrition. RESULTS: There was no death in this group of patients. The mediastinitis healed in all cases. In the follow-up period two patients did not have nutritional restriction after healing. Three patients complained of oesophageal stenosis which required oesophageal replacement (n = 2) and dilation (n = 1). One neoplastic stenosis required an endoprosthesis. CONCLUSION: Nonoperative treatment is feasible and safe in selected cases of thoracic oesophageal perforations: perforations diagnosed early and confined to the mediastinum, instrumental perforations, and perforations diagnosed late but well tolerated.

Adult↗
PubMed1996

Intraoperative esophageal manometry and fundoplications: prospective study.

The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre- and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n = 25) and posterior (partial) fundoplication (n = 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 +/- 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 +/- 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.

Esophagus↗
PubMed1996

Malignant tumors missed at laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy (LC) is now the treatment of choice for gallstone disease. The wide acceptance of LC resulted in increased cholecystectomy rates and entailed specific drawbacks such as missed malignant tumors of other organs. PATIENTS AND METHODS: The prospective follow-up of patients who underwent LC was studied, and all patients treated for malignant disease were included regarding a history of LC. RESULTS: Of 838 LCs performed, 5 patients underwent reoperation for missed carcinoma of the pancreas (n=2) and the right colon (n=3). Two other patients with carcinomas of the pancreas and the right colon had a history of LC performed elsewhere. All 7 patients (median age 72 years) complained of recent atypical pain at the time of the LC. Five tumors were resected (2 palliatively); 2 patients died. CONCLUSIONS: This study emphasizes the necessity of making a careful semiological analysis of the pain and associated symptoms before performing an LC.

Aged↗