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Biomedical subjects

F Gayral

Publications and source records attributed to F Gayral.

At least 37 records · Page 2Linked to original sources
PubMed1992

Predictability of clinicobiochemical scoring systems for early identification of severe gallstone-associated pancreatitis.

Early identification of severe gallstone-associated acute pancreatitis (GAAP) is a prerequisite for treatment with urgent endoscopic sphincterotomy. This study assesses the value of two clinicobiochemical scoring systems to this end. Over the 7-year period from 1983 to 1989, 100 consecutive patients with acute pancreatitis (45 related to gallstones, 36 to alcohol, and 19 of undetermined etiologies) had clinicobiochemical analysis within 48 hours of admission. The final diagnosis and outcome were retrospectively compared with the prediction achieved by the scoring systems. With regard to Blamey's criteria for early identification of gallstones, significant differences were found between the biliary and nonbiliary groups with respect to female sex, serum amylase concentration greater than or equal to 4,000 IU/L, alkaline phosphatase level greater than or equal to 300 IU/L, and alanine aminotransferase level greater than or equal to 100 IU/L (all p values less than 0.001). Age greater than or equal to 50 years was found to be significant (p less than 0.02) only in differentiating gallstone- versus alcohol-associated acute pancreatitis. When three or more positive factors were present, the sensitivity and specificity for predicting gallstones were 60% and 87%, respectively; the predictive value of a positive result was 79%, of a negative result 74%, and the overall accuracy was 75%. At a cutoff level of five, rather than three or more prognostic factors, the modified Ranson's criteria for patients known as having GAAP allowed a suitable discrimination of patients with an expected high risk of complications and mortality. When the two scoring systems (Blamey greater than or equal to 3 and Ranson greater than or equal to 3) were combined, 17 patients were predicted as having severe GAAP: 6 of these 17 patients were misdiagnosed as having biliary pancreatitis, whereas 9 patients with definite severe GAAP were not selected because of a Blamey score less than 3. More specific diagnostic tools are needed, and higher cutoff levels for prognostic scores are required for the prediction of severe GAAP, particularly in view of selecting patients for potentially dangerous approaches such as urgent endoscopic sphincterotomy.

Acute Disease↗
PubMed1992

Overexpression of p53: a rare event in a large series of white patients with hepatocellular carcinoma.

Mutant p53 has been found in a wide variety of human malignancies including carcinomas of the lung, breast and colon. Because of the controversial mutational rate of the p53 gene in hepatocellular carcinoma, a large series of liver tumors from white patients with different risk factors was examined immunohistochemically for expression of the p53 mutant to assess its prevalence and the relationships between p53 overexpression and clinicopathological data. Nine of 58 specimens were found to have detectable evidence of p53 gene mutation by virtue of the immunohistochemical detection of mutant p53 protein. The p53 mutation was more frequent in patients with serological hepatitis B and C markers than in patients without these markers (p = 0.046). The prevalence of p53-positive tumors was also significantly higher in the group of tumors with invaded portal branches than in the group without (p = 0.02). Our results showed that p53-positive hepatocellular carcinoma is a rare finding in patients exposed to a low dietary aflatoxin intake and that p53 mutation seems to occur at a late stage of the tumoral process and could contribute to an aggressive tumoral phenotype.

Adult↗
PubMed1987

[Anterior desinsertion of the transversus abdominalis in the prosthetic treatment of major eventrations].

An original procedure is suggested for the prosthetic treatment of major incisional hernias: transversus abdominalis muscle desinsertion. The aim is to create an opening between two cleavage planes which are the underperitoneal space externally and the posterior face of the rectus abdominalis muscle internally. The single space thus created allows the wide implantation of a subperitoneal Mersilene prosthesis which is isolated from the viscera as well as from the skin. A strong abdominal wall is then reconstituted. Ten patients were operated upon using this technique with excellent results in all cases.

Abdominal Muscles↗
PubMed1987

[Response to hepatic intra-arterial chemotherapy for metastases of colorectal cancer. Anatomo-pathological evaluation apropos of 3 cases of secondary hepatic excision].

Following intra-arterial chemotherapy (5-fluorouracil), wide hepatic resection was performed in three patients with metastases from colorectal cancer. These surgical procedures had been considered to be unfeasible before chemotherapy in two of the three cases because of the extension of the metastases. In contrast to the results of preoperative imaging techniques (CT scan, ultrasonography), the histologic response of tumors to chemotherapy was found to be significant (1/3) or complete (2/3). Since after chemotherapy these imaging procedures are unable to determine whether the observed lesions are tumoral, fibrotic or necrotic, a laparotomy after hepatic intra-arterial chemotherapy is proposed to obtain specimens for histopathologic examination and an assessment of resectability. This procedure should be reserved for patients in whom substantial benefit can be expected considering the extension of primary and metastatic disease.

Colonic Neoplasms↗
PubMed1986

[Infectious complications of diverticular sigmoiditis: can the failure of medical treatment be predicted?].

A retrospective study of case histories of 36 patients with infectious complications of sigmoid diverticulitis (excluding peritonitis) compared clinical, biologic and radiologic signs in a group responding favorably to medical treatment (24 cases) and a group requiring surgery after a mean of 9 days of treatment in a surgical ward (12 cases). Six signs were found to be related to the course of the disease: a painful left iliac mass on admission, persistence or increase in pain after 48 hours, absence of restoration of normal intestinal transit, temperature below 36.5 degrees C or above 37.8 degrees C, leucocytosis of less than 2,500 or more than 13,500/mm3, evidence of radiologic stenosis by simple contrast enema. A prospective study could assess the prognostic value of these signs as determinants of failure to respond to medical treatment.

Acute Disease↗
PubMed1983

[Acute pancreatitis: severity factors. Retrospective analysis of 78 cases].

Retrospective analysis of clinical and laboratory findings was undertaken in 78 patients in which pancreatitis was confirmed pathologically. In our experience, severity factors are as follows: age over 55 years and, during the first 48 hours, fall in haematocrit of more than 10%, corrected plasma calcium lower than 8 mg %, plasma creatinine greater than 30 mg/1, hypoxia less than 60 mm Hg, resistant to assisted ventilation, liquid sequestration more than 6 litres. These objective parameters define the group of patients who, in our experience, should derive benefit from new suggested forms of treatment.

Acute Disease↗
PubMed1983

[Postoperative cholecystitis. Apropos of 9 cases (3 lithiasic and 6 alithiasic)].

Postoperative cholecystitis (three cases with and six cases without associated stones) was found following 25.00 operations performed over a period of 8 years. Analysis of these cases and a literature review suggest that the onset of a postoperative lithiasic cholecystitis is probably only the result of coincidence, where as alithiasic cholecystitis is a definite postoperative complication, these affections having to be considered within the more general framework of post-aggression cholecystitis.

Acute Disease↗