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Biomedical subjects

H Gouerou

Publications and source records attributed to H Gouerou.

At least 19 recordsLinked to original sources
PubMed1992

Endosonography can detect residual tumour infiltration after medical treatment of oesophageal cancer in the absence of endoscopic lesions.

Endoscopic ultrasound (endosonography) is useful in the preoperative staging of oesophageal tumours. It may also have a role in evaluation and surveillance of patients with inoperable carcinomas. Thirty four patients with inoperable oesophageal cancer were investigated by endosonography and computed tomography before medical treatment. In 10 patients receiving combined chemotherapy and radiotherapy, the endoscopic lesions resolved and biopsy specimens were negative. When endosonography suggested the persistence of tumour infiltration in these patients, a local recurrence or distant metastases appeared within a few months. In contrast, when no infiltration was detected, no tumoral recurrence or progression was observed within eight months. These results suggest that endosonography is better than endoscopic biopsy specimens and computed tomography in assessing the response of oesophageal carcinoma to non-surgical treatment.

Combined Modality Therapy↗
PubMed1992

[Ivor Lewis' operation for epidermoid cancer of the esophagus. Immediate and late results. Apropos of 168 cases].

168 Ivor Lewis operations for squamous carcinoma of the lower esophagus are reviewed. 155 men and 13 women with a mean age of 59 years were operated on. 46 tumors were stage I and II, and 122 were stage III. Operations were considered to be curative for 120 patients and only palliative for 48. An esophagectomy associated with lymphadenectomy was performed through laparotomy and right thoracotomy. Feeding jejunostomy and pyloroplasty were routine. EEA or ILS 25 staplers were used to perform esophagogastric anastomosis and the gastroplasty tube was fashioned by TA 90 stapler. In every case an extended esophagectomy was performed with anastomosis between 3 ans 7 cm below the pharyngo-esophageal junction. Postoperative mortality was 4.7%. There were 10 leaks (6%) and 28 pulmonary complications. Median actuarial survival is 17 months. Actuarial survival at 2 years is significantly greater for stages I and II (68.4%) than for stage III (23.2%) (p < 0.01). Ivor Lewis esophagectomy is a reliable procedure to treat squamous carcinoma of the lower two thirds of the esophagus ensuring a good quality of life.

Adult↗
PubMed1992

[Demonstration of clonal heterogeneity in adenocarcinomas on Barrett's esophagus by flow cytometric study of cellular DNA content].

Flow cytometry was used to examine the spatial distribution of nuclear DNA content in Barrett's mucosa, in one patient with high grade dysplasia and in 6 patients with Barrett's adenocarcinoma. All tumors were aneuploid. Each adenocarcinoma but the most advanced seemed to arise from a single clone of aneuploid or near-tetraploid cells which was found in all biopsy specimens taken from the tumor. Multiple aneuploid populations of cells were seen in the larger tumors. Eight clones were individualized in the most advanced case of cancer. In all patients with carcinoma, the mucosa surrounding the tumor was aneuploid. Some areas were characterized by the same DNA index as in the tumor, others contained distinct aneuploid cell populations. The spatial distributions of aneuploid clones and dysplastic areas were not perfectly superimposed. These data suggest that neoplastic progression in Barrett's esophagus is associated with genomic instability preceding the development of malignancy. Clonal heterogeneity in Barrett's adenocarcinoma is more marked when compared to other tumors and suggests a majoration of genomic instability during tumor progression.

Adenocarcinoma↗
PubMed1991

Flow-cytometric DNA content analysis of esophageal squamous cell carcinomas.

To better understand the mechanisms of esophageal carcinogenesis, abnormalities in DNA content of esophageal squamous cell carcinomas were studied. Cellular DNA content was determined by flow cytometric study of 70 endoscopic biopsy specimens obtained from 26 patients with esophageal squamous carcinoma. High-quality histograms were obtained for 23 patients. Twenty-one patients had at least one aneuploid population in their tumor. In 7 patients, multiple aneuploid peaks were detected. Specimens from 2 patients were diploid. The interpretation of the DNA histograms was difficult in 3 patients; an aneuploid population of cells was probable in 2 of them. A statistically significant relationship was found between the degree of differentiation and DNA content abnormalities in the regions of the tumors that could be evaluated by endoscopic biopsies: well-differentiated carcinomas had diploid or small aneuploid populations containing less than 15% of the cells, whereas DNA histograms of moderately or poorly differentiated carcinomas were characterized by large aneuploid peaks representing 25%-90% of the cells and a higher proliferative fraction. No relationship was found between the size or the stage of the tumor and the DNA content detected in endoscopic biopsy samples. The frequency and the multiplicity of abnormal clones in esophageal squamous carcinomas indicates that this cancer, like esophageal adenocarcinoma, develops an association with an acquired genomic instability that produces abnormal clones of cells, according to the multistep model of neoplastic progression.

Adult↗
PubMed1991

[Polypoid pseudosarcomatous carcinoma of the esophagus. Report of two cases with favorable outcome after medical treatment].

The authors report two cases of esophageal polypoid pseudosarcoma with favorable outcome after endoscopic and medical treatment. Neither of the two patients could undergo general anesthesia. Endoscopic resection or monopolar electrocoagulation of the tumor was associated with chemotherapy and radiation therapy. A complete response of the tumor was observed in both cases. The two patients were alive and well with no evidence of recurrence or metastasis 3 and 5 years after diagnosis. Immunohistochemical study of those two tumors with monoclonal antibodies to intermediate filaments (keratin and vimentin) suggests duality in the spindle cell component. It may explain the biological behaviour of these particular cancers that have a better prognosis than other types of squamous cell carcinomas of the esophagus.

Aged↗
PubMed1991

[Flow cytometric analysis of cellular DNA content in Barret's esophagus. A study of 66 cases].

Dysplasia is the only marker for malignant potential in Barrett's esophagus. The histologic interpretation of dysplasia is sometimes difficult, particularly when attempting to distinguish dysplastic changes from those of a regenerating and inflammatory mucosa. In order to find an objective marker to identify patients with high risk of malignant transformation, the authors evaluated 497 biopsies from 66 patients with Barrett's esophagus with flow cytometry. The aim of the study was to correlate DNA content and proliferative abnormalities with histology. All biopsies classified histologically as negative for dysplasia had a diploid DNA content. The percentage of biopsies with an aneuploid DNA content increased with the histologic grade of dysplasia: 2 percent of indefinite dysplasia, 11 percent of low grade dysplasia, 44 percent of high grade dysplasia and 78 percent of biopsy specimens with cancer biopsies were aneuploid. Mean S and G2M fractions of diploid biopsy specimens increased with the severity of histologic changes. The S and G2M fraction threshold values that could differentiate patients that were negative for dysplasia from those with high grade dysplasia or cancer were 9 percent and 6 percent, respectively. Aneuploidy or G2M fraction greater than 6 percent was the best discriminating criteria between those two distinct groups of patients. All 6 patients with high grade dysplasia or cancer had aneuploid cell populations or increased G2M fraction, whereas none of the 35 patients whose biopsies were histologically negative for dysplasia had evidence of genomic instability or increased G2M fraction. Flow cytometric abnormalities were found in 10 out of 25 patients whose biopsies were classified as indefinite for dysplasia or low grade dysplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1989

Rioprostil in the short-term treatment of duodenal ulcer: a multicentre double-blind trial vs. cimetidine.

The efficacy and safety of the new prostaglandin E1 (PGE1) synthetic analogue, rioprostil, 300 micrograms b.d. and cimetidine, 400 mg b.d., on duodenal ulcer healing are compared in an international, multicentre, double-blind study. A total of 257 patients have entered the study; 243 are considered eligible for efficacy analysis and 207 for safety analysis. After 4 and 6 weeks of treatment, the endoscopic healing rates do not significantly differ between the two groups, being 55% and 83% respectively with rioprostil vs. 60% and 78% respectively with cimetidine. The major adverse effect attributable to rioprostil is diarrhoea, which was documented in 11% of patients compared with 1% of patients taking cimetidine. However, central nervous system complaints are twice as frequent in the cimetidine group. Monitoring of clinical laboratory tests show no significant abnormalities when compared with the baseline values during the administration of either drug. This study documents that rioprostil, at the dosage of 300 micrograms b.d., is as effective and safe as cimetidine in the short-term therapy of duodenal ulcer.

Anti-Ulcer Agents↗
PubMed1989

[Pancreatic sarcoidosis].

The authors report the case of a 30 year-old man with previous history of sarcoidosis, who presented with a painful infiltration of the pancreas. A review of the literature showed that symptomatic pancreatic sarcoidosis was uncommon, since only 8 other cases have been reported. Pancreatic involvement is frequently associated with hepatic infiltration (5/6 cases). Exocrine or endocrine dysfunction are possible. Diagnosis is made only at exploratory laparotomy. Prognosis is good. Steroid therapy is indicated in this peculiar type of pancreatitis, because of its long-range effectiveness on the outcome of the disease.

Acute Disease↗
PubMed1989

Alipase versus nonenteric-coated enzymes in pancreatic insufficiency. A french multicenter crossover comparative study.

Pancreatic enzymes (PE) are prepared as pH-sensitive enteric coated microspheres [Pancrease, Alipase in France (P)], to prevent gastric inactivation of orally administered enzymes. The efficacy and tolerability of P were compared to those of Eurobiol (E) (PE lacking enteric coating) in patients with exocrine pancreatic insufficiency (PI) via an open crossover study conducted at 16 centers in France. Pancreatic insufficiency was diagnosed in patients with signs of chronic pancreatitis who showed steatorrhea (fecal fat excretion greater than 8.0 g/24 h). The dosage of P was 9 capsules/d and that of E, 3 vials/d. Stools were collected for 3 consecutive days at each of the following periods: after 10 d without any PE, and after 21 d of P and E administration. Results were analyzed statistically by the method of Hills and Armitage. Chronic pancreatitis was alcohol-induced in 33 of 35 patients (94%) who entered the study. The group that received P before E (n = 20) was comparable to the group that received E before P (n = 15) in patient and disease characteristics. Eight of 35 patients failed to complete the study for the following reasons: adverse reactions 2 cases, lost to followup 4 cases, dropped out of study 2 cases. The degree of steatorrhea was similar after P and E. However, symptomatic improvement was noted far more frequently with P than with E. Moreover, patients preferred P to E because of drug taste (p less than 10(-4] and ease of drug administration (p less than 10(-3). Drug safety was comparable in the two groups of patients.

Adolescent↗
PubMed1982

[Varioliform gastritis revealed by edema with hypoproteinemia (author's transl)].

The authors report the case of a woman in whom edemas with hypoproteinemia, but without digestive symptoms, were present for several months. Roentgenography, fiberoptic endoscopy, and histopathology showed typical varioliform gastritis. Hypoproteinemia was due to plasma protein leakage into the digestive tract. Edema disappeared spontaneously while gastric pain developed.

Adult↗