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Biomedical subjects

F Michot

Publications and source records attributed to F Michot.

At least 37 records · Page 2Linked to original sources
PubMed1996

Results of artificial sphincter in severe anal incontinence. Report of 14 consecutive implantations.

PURPOSE AND METHODS: Fourteen AMS 800 (American Medical Systems, Minneapolis, MN) urinary artificial sphincters have been consecutively implanted in 13 patients with total incontinence for stool of various causes (traumatic or postoperative, 7; congenital, 3; neurologic, 2; idiopathic, 1). No proximal stoma was constructed but was already present in one patient before implantation. RESULTS: Sepsis occurred in two patients. Removal of sphincter and colostomy was necessary in three patients: one of these two had developed sepsis, one had perineal ulceration before activation of the sphincter in a severely scarred perineum, and one had severe pain in a radiation-injured anorectum. Sphincter-related failure occurred once by rupture of the cuff in a constipated woman after two years of satisfactory function. Reimplantation of a new cuff restored normal continence in this patient. After median follow-up of 20 (range, 4-60) months, nine of ten patients with a functioning sphincter were continent for stool, and five were also continent for gas. Failure occurred in one patient because the cuff was too large to occlude the anal canal. This patient is awaiting reimplantation. Four patients experienced easily controlled difficulties with evacuation of feces. Anal pressure with inflated cuff varied from 43 to 94 (mean, 58 +/- 12) cm H2O. CONCLUSION: These results show that an artificial sphincter has a role in the treatment of severe anal incontinence when local therapies are not applicable or have failed.

Adult↗
PubMed1996

Placebo-controlled clinical trial of mesalazine in the prevention of early endoscopic recurrences after resection for Crohn's disease. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives (GETAID).

OBJECTIVE: Endoscopic postoperative recurrences occur early after 'curative' surgery for Crohn's disease. Pentasa has been shown to be effective in the maintenance treatment of quiescent Crohn's disease. The aim of this study was to test the efficacy of a 12-week oral intake of Claversal in the prevention of endoscopic recurrences after 'curative' resection for ileal, colonic or ileocolonic Crohn's disease. We conducted a multicentre double-blind controlled trial comparing Claversal (1g tid) with placebo, starting within 15 days after surgery. The macroscopic normality of the two anastomotic segments was assessed at surgery. Patients were clinically and biologically evaluated twice (6-week interval), and colonoscopy was performed at 12 weeks. Endoscopic relapse was defined by any anastomotic ulcerations or stenosis and staged according to a four-grade score. RESULTS: Between May 1989 and May 1991 12 centres included 126 patients, 70 women and 56 men, aged 33 +/- 12 years (range 16-70) in the study. Disease locations were ileal, colonic and ileocolonic in 45, 6 and 49%, respectively. Claversal and placebo groups were similar at inclusion, except for ESR (37 +/- 26 vs. 27 +/- 23 mm/h in the Claversal and placebo groups, respectively; P < 0.05). Nine patients were withdrawn from the study. Adverse reactions occurred only in six patients. Five patients were excluded for protocol violation. Finally, 106 patients could be evaluated at 12 weeks (55 Claversal and 51 placebo). An endoscopic relapse was observed in 50% and 63% of the Claversal and placebo groups, respectively (P = 0.16), with a similar grade distribution. Claversal was well tolerated. CONCLUSIONS: Our study confirms that a large proportion of endoscopic recurrences occur within 3 months of resection in Crohn's disease. There was a slight trend towards greater efficacy of Claversal; it could be worthwhile trying higher dosages and/or 5-ASA compounds with different intestinal release profiles.

Administration, Oral↗
PubMed1996

Experimental measure of the tensile strength of biological sealant-collagen association after hepatectomy in dogs.

Fibrin sealants are commonly used in liver surgery. The aim of this study was to test the adhesive properties of a biological sealant-collagen bonding, using an experimental model. After hepatectomy in dogs, we measured the rupture stress point of a fibrin clot on the liver cross-section. The tensile strength was 0.28 N, 5 times higher than the force of arterial pressure in a 2-mm-diameter vessel. These results indicate that the adhesion of fibrin sealants is effective to prevent hemorrhage from the liver cross-section after hepatectomy.

Animals↗
PubMed1995

Comparison of activation marker and TCR V beta gene product expression by CD4+ and CD8+ T cells in peripheral blood and lymph nodes from HIV-infected patients.

Since lymphoid organs constitute the site of active and progressive HIV disease, analysis of their lymphocytes may provide more accurate information on T cell abnormalities than that obtained from studying peripheral blood lymphocytes. The objective of this study was to compare the expressions of activation markers and T cell receptor (TCR) V beta gene products by CD4+ and CD8+ T cells in lymph nodes (LN) and peripheral blood (PB) from healthy individuals and asymptomatic HIV-infected patients to determine whether anomalies that could be identified at the HIV replication site could support the hypothesis of T cell activation by HIV-encoded antigens or superantigens. CD4+ and CD8+ T cells in paired LN and PB obtained from six healthy controls and five asymptomatic HIV-infected individuals were analysed by flow cytometry, using anti-CD38, anti-HLA-DR and 13 anti-V beta MoAbs that cover, approximately, 45% of the T cell repertoire. Analysis of T cell activation marker expression indicated that the percentages of CD4+ and CD8+ T cells bearing CD38 or CD38 and HLA-DR molecules were higher in patients than in controls and, in patients, higher in LN than in PB. Comparison between the V beta repertoires of CD4+ and CD8+ T cells in LN and PB showed that, in each healthy individual, a limited number of V beta families expressed by CD4+ or CD8+ T cells had different repartition in LN and PB, whereas in each HIV+ patient, more V beta families exhibited different distributions and these differences recurred among certain V beta segments, such as V beta 5.3 and V beta 21 in the CD4+ T cell population and V beta 5.2/5.3, V beta 12 and V beta 21 in the CD8+ T cell population. Taken together, these data argue for a skewed TCR repertoire in HIV infection and sustained activation of T cells by HIV-encoded antigens at the site of HIV replication, and further demonstrate that a high proportion of CD4+ T cells are in an activation state that may, indirectly, participate in their functional abnormalities.

Adult↗
PubMed1995

[Infrahepatic ectopic non-secreting chromaffin tumor].

An ectopic, nonsecreting chromaffin tumour was revealed by vena cava compression responsible for pulmonary embolism. Based on radiological findings, the first hypothesis was a hepatic cystic tumour. The final diagnosis was confirmed by histological examination of the tumour. Ectopic sites of adrenal tumours and their embryology, diagnosis and therapeutic problems are discussed in the light of this case.

Adrenal Gland Neoplasms↗
PubMed1994

[Study with flow cytometry of the peritumoral mucosa adjacent to colorectal cancers].

Tumour and peritumoral mucosa were analyzed using flow cytometry in 21 consecutive patients operated on for colorectal carcinoma. Thirteen tumours were DNA aneuploid. No foci of aneuploidy bordering the tumours were detected, regardless of the tumour type. On the other hand, a significant decrease in the proliferative index was observed adjacent to the DNA aneuploid tumours. This study provides an additional argument for segmentary excision in colorectal cancers. Complementary studies are still required to specify the mechanisms of proliferation inhibition in the area of the DNA aneuploid tumours.

Aged↗
PubMed1994

[Anorectal manometry and ileo-anal anastomosis: pre- and postoperative manometric comparison].

The aim of this study was to evaluate the physiological and manometric changes of anorectal function after proctocolectomy and ileal J pouch anastomosis performed in 13 patients. A short muscular rectal cuff was conserved in the first 5 patients, mucosectomy was performed in the next patients (Group M), and the entire rectum and proximal portion of the anal canal (1 mm above the dentate line) were resected without mucosectomy (Group WM) in the most recent patients. With a median postoperative follow-up of 18 months, anorectal continence was perfect in 9 patients, and minimal incontinence were observed in 4 patients (2 patients in Group M, and 2 patients in Group SM). In Group M, the resting lower anal canal pressure was significantly decreased after the operation and was less than the postoperative resting lower anal canal pressure observed in Group SM. The resting upper anal canal pressure in continent patients was inferior to the postoperative values measured in patients with minimal incontinence. In all the groups, no change in squeeze pressure was observed after the operation. During the postoperative period, the rectoanal inhibitory reflex was absence in all patients. The volume necessary for sensation threshold was increased after the operation, in the same number of patients in Group M and SM, and more frequently in continent patients compared with patients with soiling. The absence of muscular rectal cuff and mucosectomy seems to provide best results than rectal cuff preservation. After the operation, a marked decrease in the resting pressure and an increase in the volume necessary to onset of threshold sensation, were associated with the presence of minimal incontinence.

Adult↗
PubMed1993

[Anal incontinence. Critical study of the surgical treatment].

Two million French people aged over 45 are thought to suffer from faecal incontinence. The most frequent anatomical or functional causes of this disability are: idiopathic incontinence of falling down perineum due to denervation of its striated muscle; some neurological diseases; rupture or destruction of the sphincter due to traumatic, iatrogenic or obstetrical causes; complete rectal prolapse. Each of these situations has its medico-surgical solution (post-anal repair, sphincterorrhaphy, rectopexy, Delorme's operation, myoplasty, artificial sphincter), always bearing in mind that the fundamental aim is to correct the handicap and restore a good quality continence.

Anal Canal↗
PubMed1993

Measuring the rupture stress point of biological sealant-collagen bonding: validation of a technique used after hepatectomy.

The aim of this experimental study was to measure the rupture stress point of a fibrin clot situated on a liver, in realistic surgical conditions. The experimental method was carried out with a machined wooden cylinder bonded on the liver, connected with a wire to a setup and pulled at a constant speed, and a sensor was placed on the wire measuring the applied strength. This method, realized in the dog, made it possible to validate a precise and reproducible method designed for testing the adhesive characteristics of biological sealant-collagen bonding on the liver.

Adhesiveness↗
PubMed1992

[Disorders of relaxation of the lower esophageal sphincter appearing after resection of a mid-thoracic esophageal pulsion diverticulum].

A pulsion diverticulum of the mid-thoracic oesophagus was resected because of severe dysphagia. A subdiverticular myotomy was associated for the treatment of non-propagated oesophageal contractions, without oesophageal low-sphincter abnormalities. Three months post-operatively, the dysphagia was still present and manometry showed the absence of lower sphincter relaxation after 45 percent of deglutitions; a lower oesophageal sphincter myotomy was performed, resulting in correction of the dysphagia and of the sphincter relaxation abnormalities. The deficit of the inhibitory nervous mechanism, responsible for abnormalities of lower oesophageal sphincter relaxation, was present in the entire intramural oesophageal plexus, but, was not symptomatic at the level of the IOS prior to resection of the diverticulum.

Acute Disease↗