Biomedical subjects

D Pezet

Publications and source records attributed to D Pezet.

82 records · Page 5Linked to original sources

PubMed1985

[Mediastinoscopy in the evaluation of the operability of bronchial cancer].

Mediastinoscopy is an invasive technique used to explore the anterior and upper mediastinum. The axial mediastinum and its lymph nodes are explored through the cervical approach, and the pulmonary vessels and anterior mediastinal lymph nodes through the parasternal approach. Bronchial carcinomas which extend to the mediastinum, either via the lymphatic system or by contiguity, are of extremely severe prognosis. The advent of mediastinoscopy has considerably reduced the number of exploratory thoracotomies and therefore the operative mortality rate, while increasing the resectability rate to 95%. It has also narrowed the indications for surgery without decreasing the number of curative resections. In the hands of experienced operators, the technique has a low morbidity rate. CT examination is not as accurate as mediastinoscopy to evaluate the mediastinal extension of bronchial carcinomas, but it can help to lay down the indications for the invasive technique, thereby limiting its use to selected cases.

Aged↗

PubMedDate not supplied

Laparoscopic cholecystectomy: an original three-trocar technique.

At present, laparoscopic cholecystectomy is the treatment of choice for gallbladder stones. The operating technique reported by most authors includes the use of four trocars. We report a group of 710 consecutive patients treated by an original three-trocar technique. The use of the fourth trocar was necessary in only 55 cases (8%). However, among 56 cases of acute cholecystitis the use of the fourth trocar was necessary in 14 cases (25%) (p < 0.01). Twenty-six laparoscopies were converted to open procedures (3.6%). Four common bile duct injuries were observed (0.5%): two of them among the 655 operations with three trocars (0.3%) and two after application of the fourth trocar at the beginning of the procedure because of dissection difficulties. Our results are similar to those using the "classic" four-trocar technique. Moreover, this technique is less expensive and allows one less scar.

Acute Disease↗

PubMedDate not supplied

Management of splenic artery aneurysms and false aneurysms with endovascular treatment in 12 patients.

PURPOSE: To assess the endovascular treatment of splenic artery aneurysms and false aneurysms. METHODS: Twelve patients (mean age 59 years, range 47-75 years) with splenic artery aneurysm (n = 10) or false aneurysm (n = 2) were treated. The lesion was asymptomatic in 11 patients; hemobilia was observed in one patient. The lesion was juxta-ostial in one case, located on the intermediate segment of the splenic artery in four, near the splenic hilus in six, and affected the whole length of the artery in one patient. In 10 cases, the maximum lesion diameter was greater than 2 cm; in one case 30% growth of an aneurysm 18 mm in diameter had occurred in 6 months; in the last case, two distal aneurysms were associated (17 and 18 mm in diameter). In one case, stent-grafting was attempted; one detachable balloon occlusion was performed; the 10 other patients were treated with coils. RESULTS: Endovascular treatment was possible in 11 patients (92%) (one failure: stenting attempt). In four cases among 11, the initial treatment was not successful (residual perfusion of aneurysm); surgical treatment was carried out in one case, and a second embolization in two. Thus in nine cases (75%) endovascular treatment was successful: complete and persistent exclusion of the aneurysm but with spleen perfusion persisting at the end of follow-up on CT scans (mean 13 months). An early and transient elevation of pancreatic enzymes was observed in four cases. CONCLUSION: Ultrasound and CT have made the diagnosis of splenic artery aneurysm or false aneurysm more frequent. Endovascular treatment, the morbidity of which is low, is effective and spares the spleen.

Aged↗

PubMedDate not supplied

Evaluation of the 5' spliced form of human cathepsin B mRNA in colorectal mucosa and tumors.

To evaluate the 5' spliced form of human cathepsin B mRNA in colorectal mucosa and tumors, we have determined the ratio of the spliced form for the exon 2/the complete form of cathepsin B mRNAs obtained by RT-PCR. Such ratio is significantly higher in colorectal tumors than in colorectal mucosa (p < 0.05, Kruskal-Wallis test) or in skeletal muscle (p < 0.05). Moreover, 2-fold more complete form than the spliced mRNA was found in the tumors than in the colorectal mucosa. Our data indicate that the alternative splicing of human cathepsin B mRNA in the 5'UTR may be considered as an indicator of the cellular transformation, in colorectal cancer.

Alternative Splicing↗

PubMedDate not supplied

Phase II trial of chronomodulated infusion of 5-fluorouracil and folinic acid in metastatic colorectal cancer.

Forty three patients with metastatic colorectal cancer (MCC) received a daily administration of 5-fluorouracil (600 mg/m2/d at the first course, 700 mg/m2/d at the second and 800 mg/m2/d at the third course), and l-folinic acid (150 mg/m2/d) or dl-folinic acid (300 mg/m2/d) both chronomodulated from 22:00 to 10.00 am with peak delivery rate at 4.00 for 5 days every 21 days. Only severe mucositis and diarrhea occurred in 19 courses (5.7% Gr 3; 0.6% Gr 4) in 14 patients. Objective response (OR) was evaluated in 40 patients because of one toxicity and two early progressions. No OR was observed in the 15 previously-treated patients versus 28.5% (8/28) partial responses in chemotherapy naïve patients; overall the median survival was 13 months. These results without toxicity and with low OR rate indicate the necessing of a more intensive treatment and confirm the place of oxaliplatin in the chemotherapy of MCC.

Adult↗

PubMedDate not supplied

Randomized trial of 5-fluorouracil, leucovorin and cisplatin in advanced pancreatic cancer.

BACKGROUND/AIMS: Phase II trials of combined 5 fluorouracil, leucovorin and cisplatin have demonstrated an 18-28% response rate in advanced pancreatic carcinomas. We investigated the effect of this chemotherapy regime on patients' survival. METHODOLOGY: Patients included gave informed consent. They had an advanced and proven pancreatic adenocarcinoma. The trial was multicentric, prospective and randomized. It compared a 5-day course of leucovorin (200 mg/m2/day), 5-fluorouracil (375 mg/m2/day) and cisplatin (15 mg/m2/day) repeated every 21 days (23 patients) with a control group (22 patients). The main end points were survival time (Kaplan-Meier and log-rank methods) a[not readable: see text]side effects of chemotherapy. RESULTS: Association of leucovorin, 5-fluorouracil and cisplatin failed to demonstrate any advantage of this regimen compared with supported care alone. Median survival times were 8.6 months (SD +/- 1.8) and 7.0 months (SD +/- 0.6), respectively. The modulation of 5-fluorouracil by leucovorin and cisplatin was well tolerated with moderate toxic effects. CONCLUSIONS: This multicentric trial failed to demonstrate any advantage of the evaluated chemotherapy regime in the palliative treatment of cancer of the exocrine pancreas. Other trials including gemcitabine and/or radiotherapy are needed in advanced pancreatic adenocarcinoma.

Adenocarcinoma↗

PubMedDate not supplied

Localization of human BRCA1 and BRCA2 in non-inherited colorectal carcinomas and matched normal mucosas.

We characterized the expression of BRCA1 and BRCA2 in 38 sporadic colorectal carcinomas and matched normal mucosas with 9 anti-BRCA1 antibodies and 4 anti-BRCA2 antibodies, raised against several different epitopes, using immunohistochemical technique. We demonstrated an increased BRCA1 and BRCA2 staining in the apical cell pole of epithelial malignant cells and we also revealed a significant increase in BRCA1 and BRCA2 nuclear foci in tumor colorectal specimens in comparison with corresponding normal tissues. These increases in BRCA1 and BRCA2 expression may be explained by the fact that colorectal tissue is subject to very active proliferation and differentiation.

Adult↗

PubMedDate not supplied

Specific receptors for 1,25-dihydroxyvitamin D3 (1,25-DR) and human colorectal carcinogenesis.

Because it is a common prerequisite for steroid responsiveness in target tissue, we investigated the presence of specific 1,25-DR in spontaneous human colorectal adenocarcinomas (ADC) and adjacent normal-appearing mucosa (NAM) from 23 operative specimens (12 male and 11 female patients). 1,25-DR was determined in cytosol by a DCC assay technique. 1,25-DR was present in 21 of 23 NAM and in only 4 of 23 HCRA. All positive ADC were well differentiated. Receptor content expressed in femtomoles/mg of protein (mean +/- SEM) was respectively 63.9 +/- 7.6 for right colon NAM and 51.3 +/- 12.9 for left colon or rectum NAM. When we compared all NAM specimens, receptor content was 56.7 +/- 8.0 femtomoles/mg of protein. No difference in 1,25-DR NAM level was observed between right colon and left colon or rectum. In adenocarcinoma the mean content was 66.5 +/- 14 fmoles/mg of protein. Scatchard analysis showed a single class of specific high-affinity saturable 1,25-DR with a dissociation constant (Kd) of 0.97 +/- 0.57 and 1.03 +/- 0.39 chi 10(-10) M in NAM and ADC respectively. These preliminary data represent the first demonstration of 1,25-DR throughout the entire human colon and indicate that the receptivity for this hormone is often lost during malignant transformation of the human colorectal mucosa. In addition, 1,25-DR could be a marker of differentiation in ADC. These preliminary results provide evidence supporting the addition of Vitamin D to the roster of developmental cancer chemopreventative agents.

Adenocarcinoma↗

PubMedDate not supplied

Pharmacokinetic study in carboplatin, cisplatin and 5-fluorouracil regimen for advanced oesophageal cancer.

A chemotherapy using carboplatin, cisplatin and 5-fluorouracil in continuous infusion for advanced oesophageal cancer showed a high response rate in a previous feasibility study. The overall CT-scan response rate of 85% was obtained with a haematological dose-limiting toxicity: neutropenia and thrombopenia grade 3-4 of 23% and 30% respectively. In order to correlate myelosuppression with pharmacokinetic parameters, a pharmacological study was undertaken. The area under curve (AUC) of ultrafiltrable platinum and the residual rate of total platinum in 16 patients were tested. The measured creatinine clearance was found to be predictive of the subsequent myelosuppression. Plasma samples were using daily using the atomic absorption spectrometry technique. A strong relationship in individual patients was underlined between the AUC of ultrafiltrable platinum or residual rate of total platinum and the lowest platelet count for the first 3 days of treatment (p < 0.05). Conversely, the threshold value of the AUC at day one and residual rate at days two and three were calculated to prevent a highly probable haematotoxicity. Therefore, an optimal dose of carboplatin is determined in relation to the renal function of each patient.

Adenocarcinoma↗

PubMedDate not supplied

Laparoscopic myotomy for primary esophageal achalasia: prospective evaluation.

BACKGROUND/AIM: The feasibility and safety of the laparoscopic myotomy having been previously demonstrated, the purpose of this prospective study was to evaluate its effectiveness. MATERIALS AND METHODS: Eight patients with primary esophageal achalasia underwent a laparoscopic modified Heller's myotomy with a posterior fundoplication. Early post-operative course has been uneventful in all cases. Clinical, endoscopic, and manometric prospective evaluations were performed with a median follow-up of 21 months (range 4-40). RESULTS: Excellent or good clinical results were present in all cases. Endoscopic studies were normal in all cases and the post-operative esophageal manometry (n = 7) showed that the median pressure of the lower esophageal sphincter decreased to 8.5 mmHg (range 3-9) which was significant compared to the median pre-operative value of 35 mmHg (p < 0.01). CONCLUSION: Though this experience is limited, these mean-term results suggest that the laparoscopic myotomy is effective to treat achalasia. It combines the efficacy of surgery and the minimally invasive aspect of dilatations. Thus, a prospective controlled trial comparing laparoscopic myotomy and dilatations is needed.

Adult↗