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Biomedical subjects

F X Caroli-Bosc

Publications and source records attributed to F X Caroli-Bosc.

At least 19 recordsLinked to original sources
PubMed2001

[Intestinal obstruction in cancer patients: results of palliative surgery].

OBJECTIVE: The study aim was to investigate predictive factors related to the results, in terms of survival and quality of life, of palliative surgery in cancer patients presenting with intestinal obstruction. METHODS: A total of 109 patients already treated for a neoplasm were operated on for intestinal obstruction between 1990 and 2000. The investigated prognostic factors were age, sex, location of the primary tumour, extension of the cancer at the time of the operation and the surgical procedure carried out. The impact on the quality of life was assessed by the resumption of intestinal transit and the return home. RESULTS: The median survival rate was 64 days and the postoperative mortality rate 21%. The quality of life was improved in 65% of the patients. The only factors clearly correlated with survival and the success of the operation were the aetiological diagnosis of the intestinal obstruction and the type of procedure which was possible to carry out. CONCLUSION: Palliative surgery may improve the quality of life of a certain number of patients, but it was not possible to demonstrate predictive factors for the selection of patients who could have the larger benefits of such surgery.

Adult↗
PubMed2001

A weekly 24-h infusion of high-dose 5-fluorouracil (5-FU)+leucovorin and bi-weekly cisplatin (CDDP) was active and well tolerated in patients with non-colon digestive carcinomas.

In patients with non-colon digestive carcinomas, various schedules and doses of 5-fluorouracil (5-FU) and leucovorin combined with cisplatin (CDDP) have been used extensively. The present study explored the toxicity and activity of a weekly 24-h infusion of high dose 5-FU modulated by high dose leucovorin with bi-weekly CDDP. 59 patients with measurable disease were treated with a weekly infusion of high dose 5-FU (2 or 2.6 g/m2)+leucovorin 500 mg/m2 for 6 weeks and a bi-weekly dose of CDDP (50 mg/m2). All patients had metastatic or locoregionally advanced disease and had a performance status < or =3. All patients were evaluable for toxicity and 58 for response. Toxicity was different according to the schedule of 5-FU. Serious adverse events occurred most frequently when 5-FU was given at a dose of 2.6 g/m2 with a high incidence of grade 3/4 neutropenia (16%) and febrile neutropenia (13%), and led to dose reductions in both CDDP and 5-FU in 13 patients (34%). For patients who started 5-FU at a dose of 2 g/m2, no reduction in 5-FU was required, and only 4 patients required a dose reduction of CDDP (19%). Grade 3/4 neutropenia was seen in 10% of patients of this group and only 1 patient required hospitalisation for febrile neutropenia. Other grade 3/4 toxicities were rare in both groups. Renal toxicity was infrequent and mild and did not require dose adjustments. The overall response rate was 33%; 19 patients achieved a partial responses (PR). No patient had a complete response (CR). The median duration of response was 5.7 months (range 2-24 months) and the median survival was 7.9 months ( range: 1-30, 95% confidence interval (CI): 7-9). The combination of weekly 24-h infusion of high dose 5-FU with leucovorin and bi-weekly cisplatin seems a well-tolerated and active treatment in non-colon digestive carcinomas. A dose of 2 g/m2 of 5-FU seems to be recommended.

Adult↗
PubMed2001

Role of fibrates and HMG-CoA reductase inhibitors in gallstone formation: epidemiological study in an unselected population.

Fibrate derivatives and HMG-CoA reductase inhibitors modify homeostasis of cholesterol. The aim of this study was to assess in an unselected population whether these hypolipidemic drugs are risk factors for cholelithiasis or, conversely, are protective agents. Both sexes, all socioeconomic categories, pregnant women, and cholecystectomized subjects were included. Clinical data collection and gallbladder ultrasonography were both carried out in a double-blind fashion. Fibrate derivatives were predominantly fenofibrate, HMG-CoA reductase inhibitors were simvastatin and pravastatin. On univariate analysis, age (>50 years), sex, and use of fibrates were found to be significantly related to the presence of cholelithiasis. Age, sex, and fibrate treatment remained independently correlated with the presence of gallstones on multivariate analysis. With fibrates, the relative risk for lithiasis was 1.7 (P = 0.04). The HMG-CoA reductase inhibitors were not associated with a protective effect on univariate analysis. Of the lipid-lowering drugs, only fibrate derivatives were found to increase the risk of gallstone formation.

Anticholesteremic Agents↗
PubMed2001

Survival and quality of life after palliative surgery for neoplastic gastrointestinal obstruction.

OBJECTIVE: The aim was to identify the prognostic factors which relate to the results, in terms of survival and quality of life, of palliative surgery in cancer patients presenting with an occlusion. METHODS: The files of 109 patients with a neoplasm who were operated on for occlusion between 1990 and 2000 have been re-examined. The prognostic factors studied were age, sex, the location of the primary tumour, the extension of the cancer at the time of the operation, and the surgical procedure carried out. The impact on the quality of life was assessed by the resumption of transit and the return home. RESULTS: The median survival was 64 days and the peroperative mortality was 21%. The quality of life of patients has been improved in 65% of cases. The only factors clearly correlating to survival and the success of the operation are the aetiological diagnosis of the occlusion (local recurrence better than carcinomatosis) and the type of procedure it was possible to carry out (resection better than bypass). CONCLUSION: Palliative surgery can, in a certain number of cases, improve the quality of life of patients, but it has not been possible for us to demonstrate prognostic factors which would allow the selection of patients who could benefit the most from such surgery.

Adult↗
PubMed2000

Ascending colonic variceal bleeding: utility of phase-contrast MR portography in diagnosis and follow-up after treatment with TIPS and variceal embolization.

The authors describe the discovery of ascending colonic variceal veins via celiomesenteric diagnostic angiography following a bout of melena in a 44-year-old woman. Magnetic resonance imaging, including phase-contrast MR venography, allowed visualization of the portal and systemic veins immediately after the initial angiograms. The hemorrhagic episode did not resolve until after transjugular intrahepatic shunt insertion and selective variceal embolization through the shunt. At 1 week-, 3 months-, and 6 months post treatment, follow-up MR venography no longer revealed the presence of colonic varices. Colonoscopy at 6 months was normal and the patient did not have any further episodes of bleeding until a liver transplantation was performed after 9 months.

Adult↗
PubMed2000

Endoscopic bilateral metal stent placement for malignant hilar stenoses: identification of optimal technique.

BACKGROUND: The aim of this study was to identify factors that facilitate bilateral insertion of metal stents in malignant hilar stenoses, for which plastic stents often result in incomplete drainage and subsequent cholangitis. METHODS: Between January 1994 and April 1998, we collected 45 cases of advanced (Bismuth stage II or higher) hilar malignant stenoses. The insertion technique was progressively modified and the success rate in the early period (1994 to 1995) was compared with that of a later period (1996) and the most recent period (1997 to 1998). RESULTS: Overall success rate was 73.3% (33 of 45). The success rates for the three periods were 50%, 67%, and 88% (p = 0.008), respectively. Cholangitis occurred in 3 of the patients with unilateral stents compared with 1 with bilateral stents. CONCLUSION: We have described a technique for endoscopic insertion of bilateral metallic stents for malignant hilar stenoses that results in high (>88%) and reproducible success rates.

Aged↗
PubMed2000

Endoscopic management of sump syndrome after choledochoduodenostomy: retrospective analysis of 30 cases.

BACKGROUND: Side-to-side choledochoduodenostomy is a frequently performed operation. Postoperative biliary "sump syndrome" is infrequent, a complication for which endoscopic sphincterotomy is regarded as the treatment of choice. METHODS: We retrospectively analyzed 30 cases of sump syndrome and describe the symptoms, the delay before the appearance of symptoms, laboratory abnormalities, the nature of the biliary obstruction, and the outcome of endoscopic sphincterotomy including its efficiency and complications. RESULTS: The median clinical latency was 5 years (range 1 month to 28 years), the median delay between surgery and diagnosis was 6 years (range 1 month to 28 years). Fourteen patients had abdominal pain with fever, 5 had isolated abdominal pain, 4 had post-prandial pain, 4 had hepatic abscesses, and 3 had acute pancreatitis. Liver function tests were abnormal in 79%. During endoscopic retrograde cholangiopancreatography, food debris was identified in 18 patients in the biliary sump, biliary calculi in 10 patients, and a mixture of food and calculi in 2 patients. All patients underwent endoscopic sphincterotomy without complication. Recurrence during a median follow-up of 36 months (range 3 months to 11 years) was not observed. CONCLUSIONS: Sump syndrome most often becomes symptomatic only after a long delay. Abdominal pain with fever was the most frequent symptom. Liver function tests were abnormal in the majority of patients. Food debris was the most frequent cause. Endoscopic sphincterotomy appeared to be a safe, reliable treatment.

Adult↗
PubMed2000

A new source of drug-induced acute pancreatitis: codeine.

A variety of drugs have been reported to cause acute pancreatitis during the past 40 years. We report the first series of four cases of acute pancreatitis related to codeine ingestion. Four patients (three female, mean age 50.2 yr) presented with clinical, biochemical, and radiological evidence of acute pancreatitis. All four had ingested a therapeutic dose of codeine 1-3 h before the onset of abdominal symptoms. Unintentional rechallenge occurred in three cases and was followed by recurrence of acute pancreatitis in all three. All patients made a full recovery. All four patients had had a previous cholecystectomy. The likely underlying pathophysiological mechanism is codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Codeine ingestion leads to acute pancreatitis in some individuals. Previous cholecystectomy seems to predispose to codeine-induced pancreatitis.

Acute Disease↗
PubMed1999

Endoscopic Nd:YAG laser therapy for villous adenomas of the right colon.

BACKGROUND: Endoscopic laser therapy is considered an acceptable treatment of benign colorectal adenomas. The aim of our study was to evaluate the efficacy of Nd:YAG laser to ablate right-sided colonic sessile adenomas. METHODS: Between January 1990 and February 1996, 56 patients underwent laser therapy because of high operative risk or refusal of surgery. Lesions were located as follows: cecum (23), ascending, (15), and hepatic flexure (18). Six patients (10.7%) had multiple polyps in the ascending colon. Histologic examination showed a tubulovillous pattern in 20 (35.7%) and a villous pattern in 36 (64.3%). Low-grade dysplasia was detected in 44 patients (78. 5%) and high-grade dysplasia in 12 (21.4%). RESULTS: The number of laser sessions ranged between 1 and 6 (median 3) and complete ablation, histologically confirmed, was achieved in 49 cases (87.5%). Seven patients (12.5%) underwent surgery: 2 for incomplete tumor destruction, 3 because of invasive carcinoma on repeated biopsies. Two patients (3.6%) had complications (one perforation of the cecum and one hemorrhage). Follow-up ranged from 6 to 60 months and no recurrences were observed. CONCLUSION: Laser therapy is an effective method for the destruction of sessile adenomas of the right colon in selected patients.

Adenoma, Villous↗
PubMed1999

A prospective study of pancreatic disease in patients with alcoholic cirrhosis: comparative diagnostic value of ERCP and EUS and long-term significance of isolated parenchymal abnormalities.

BACKGROUND: The prevalence of pancreatic disease in patients with alcohol-related liver cirrhosis is uncertain. We assessed the prevalence of pancreatic abnormalities in patients with alcoholic cirrhosis, and we compared endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) for the detection of chronic pancreatitis and other pancreatic lesions. In addition, we assessed the long-term significance of isolated pancreatic parenchymal abnormalities detected at EUS. METHODS: EUS and ERCP were performed in each patient. Subjects with minimal parenchymal changes at initial EUS underwent clinical follow-up and subsequent EUS and/or ERCP to document the occurrence, absence, or progression of these changes. RESULTS: Seventy-two patients with alcoholic cirrhosis were recruited. Chronic pancreatitis was diagnosed in 14 patients (19%) by both methods independently. Isolated parenchymal lesions were observed in 18 patients by EUS alone. After a mean follow-up of 22 months the EUS appearance was unchanged. Ten of the 18 patients underwent follow-up ERCP and this was normal in all cases. CONCLUSIONS: This study demonstrated that (1) 19% of patients with alcoholic cirrhosis have chronic pancreatitis, (2) an additional 25% have isolated pancreatic parenchymal changes at EUS, and (3) these parenchymal abnormalities do not progress during follow-up.

Aged↗
PubMed1999

Prevalence of cholelithiasis: results of an epidemiologic investigation in Vidauban, southeast France. General Practitioner's Group of Vidauban.

Cholelithiasis leads to 80,000 cholecystectomies being performed every year in France, but its prevalence is still unknown. The aim of this study was to assess the prevalence and risk factors of cholelithiasis in a random population of 1027 women and 727 men over the age of 30 in a small town in the southeast of France. Detailed clinical history, dietary investigation, and gallbladder ultrasound were collected for each subject and assessed by univariate analysis. A regression model was used in the multivariate analysis to detect the relative risk of cholelithiasis. Cholelithiasis was found in 130 individuals (global prevalence 13.9%). The relative risk for lithiasis was higher in women compared to men (1.89). Age (P<0.0001) and body mass index (BMI) >25 (P = 0.013) were also significant risk factors. Neither pregnancy nor oral contraceptive use proved to be risk factors. Typical biliary colic pain was the only symptom significantly associated with cholelithiasis (P<0.0001). These results show that the prevalence of gallstones in France is similar to that in Denmark and Italy.

Adult↗
PubMed1999

Effect of endoscopic sphincterotomy on bile lithogenicity in patients with gallbladder in situ.

BACKGROUND AND STUDY AIMS: Endoscopic sphincterotomy results in a continuous flow of bile into the duodenum and consequently leads to an increase in the frequency of enterohepatic bile acid cycling. Because bile acids are the driving force of biliary secretion, sphincterotomy may affect bile genesis. The present study was undertaken to determine the influence of endoscopic sphincterotomy on bile composition. PATIENTS AND METHODS: The cholesterol saturation index and the bile acid pattern were determined in the gallbladder bile of lithiasis patients with (group III) or without sphincterotomy (group I), and in the hepatic bile of patients with gallbladder in situ who were checked at 3 months after the endoscopic procedure (group II). Stones from each patient were examined for chemical composition and microstructure. RESULTS: All the patients had cholesterol stones. After endoscopic sphincterotomy the molar percentages of cholesterol in the gallbladder bile of group III and in the hepatic bile of group II were significantly lower (-31% and -46% respectively) than in group I. Similarly, the cholesterol saturation index in the hepatic bile (0.79) and the gallbladder bile (0.86) from patients who had undergone sphincterotomy indicated undersaturation whereas bile from group I was oversaturated (1.25). On the other hand, endoscopic sphincterotomy did not modify the hydrophobicity index of the bile acid pool, even though deoxycholate content increased. CONCLUSIONS: Endoscopic sphincterotomy causes a marked decrease in the lithogenicity of bile and thus may prevent the risk of recurrence of cholesterol lithiasis.

Absorptiometry, Photon↗
PubMed1999

Second generation of the automated Cobas Amplicor HCV assay improves sensitivity of hepatitis C virus RNA detection and yields results that are more clinically relevant.

The first and second generations of the Cobas Amplicor HCV assay were compared among patients at risk of hepatitis C virus (HCV) infection. The second-generation test was found to be of greater sensitivity and of good specificity among clinical specimens containing HCV RNA of different genotypes. Finally, this new test is shown to predict the outcome of interferon therapy better.

Hepacivirus↗
PubMed1999

[Multifocal MALT lymphoma and acute cytomegalovirus gastritis revealing CD4 lymphopenia without HIV infection].

We report the case of a 63 year-old female who presented with a seven-year history of epigastric pain and a sudden overall deterioration. Gastroscopy demonstrated inflammatory aspect and ulceration in the antrum and fundus. Histology showed a lymphocytic infiltrate consistent with low grade mucosa-associated lymphoid tissue lymphoma and cytomegalovirus gastritis. There was no evidence of Helicobacter pylori infection. Other investigations demonstrated two pulmonary foci consistent with lymphomatous infiltration and a reduced CD4 + T-lymphocyte count (85/mm3). Other screening tests including HIV serology were negative. This case of idiopathic CD4 lymphopenia, in conjunction with the other rare cases in the literature, allows us to reevaluate this condition and its unusual clinical presentation with two opportunistic pathologies.

Acute Disease↗
PubMed1999

Extensive aetiological investigations in acute pancreatitis: results of a 1-year prospective study.

BACKGROUND: Epidemiological data on acute pancreatitis are poorly defined. AIMS: To prospectively evaluate the aetiology of acute pancreatitis and to assess the benefits of intensive investigations. METHODS: In a prospective, 1-year study all cases of acute pancreatitis in the Nice catchment area were enrolled. Subjects underwent routine (serum calcium, phosphate and triglycerides; abdominal ultrasonography and CT scan) and additional, delayed intensive investigations (ERCP with bile sampling and/or endoscopy ultrasonography). RESULTS: One hundred and twenty-one cases were included. After routine investigations, a biliary, alcoholic, miscellaneous or unknown origin was diagnosed in 43%, 31.4%, 9.9% and 15.7%, respectively. In subjects with biliary pancreatitis, 43% had no previous history of biliary disease. In the alcohol-related subgroup, pancreatitis recurred in 18.5% during 114.5 days mean follow-up. In subjects with a first episode of alcoholic pancreatitis, delayed supplemental investigations revealed underlying chronic pancreatitis in 92.8%. After routine investigations, a diagnosis of pancreatitis of unknown origin was made in 15.7% (n = 19) of subjects. Additional investigations revealed an underlying cause in 57.8% of these patients (n = 11), including malignancy (n = 3) and biliary disease (n = 4), reducing the overall rate of pancreatitis with no apparent cause to 6.6%. CONCLUSIONS: Investigative techniques, particularly ERCP, will reveal the underlying aetiology of pancreatitis in the majority of patients presenting with 'idiopathic' pancreatitis and should be considered when routine tests are negative.

Acute Disease↗
PubMed1998

A study of the effect of age on pancreatic duct morphology.

BACKGROUND: Interpretation of endoscopic pancreatograms is difficult in elderly patients. Age-related parenchymal changes and associated ductographic changes are ill-defined, and it is sometimes difficult to distinguish these from pathologic processes. METHODS: To define age-related pancreatogram changes, all endoscopic retrograde pancreatograms performed in patients older than 70 years of age over a 6-year period were analyzed and compared with those of a control group (younger than 50 years of age). RESULTS: Of the 136 elderly subjects included in the study, 31 (22.8%) were found to have definite pathology. Comparing the remaining 105 subjects with the control group, the mean main pancreatic duct diameter (in millimeters) was larger in the head (5.3 vs. 3.3), body (3.7 vs. 2.3), and tail (2.6 vs. 1.6) (p < 0.05). The duct diameter also increased significantly in each of the age cohorts (70 to 79, 80 to 89, and 90 to 99 years). Only 33 of 105 (31.4%) of the elderly patients had duct diameters within defined normal limits. In the majority (63.3%), dilatation was global but in a minority it was confined to the head and/or body. In 21 subjects the ductal diameter was greater than 2 standard deviations above normal, and in 5 subjects it was greater than 3 standard deviations above normal. Dilatation of secondary ducts was also observed. CONCLUSION: The majority of elderly patients who do not have pancreatic pathology have a dilated pancreatic duct by comparison with younger patients. Patient age must be considered when interpreting endoscopic pancreatograms.

Adolescent↗
PubMed1998

Hepatitis G and C viruses respond to interferon-alpha with different virologic kinetics.

The aim of this work was to specify the time course of response to interferon (IFN) of hepatitis G virus (HGV) and hepatitis C virus (HCV) in coinfected individuals. A group of 33 patients, undergoing 12 months of IFN therapy for chronic hepatitis C, was screened for the presence of both HGV and HCV RNAs to select seven coinfected patients. Spontaneous recovery from HGV infection was excluded through the detection of antibodies to the envelope-2 protein of HGV and HCV isolates were genotyped. Within three months of treatment, we found that HGV RNA was transiently cleared in 6/7 patients, but the rate of long-term favorable response was very low (1/7). In addition, considering the same individuals separately, it was shown that HGV and HCV responded to IFN with different kinetics in 5/7 patients. Taken together, these results underscore the importance of the virological basis of the resistance to IFN treatment.

Antiviral Agents↗