Biomedical subjects
H Joyeux
Publications and source records attributed to H Joyeux.
Complete liver regeneration in one-stage 90% hepatectomized rats treated with testosterone.
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Accuracy of intraoperative ultrasonography in diagnosing liver metastasis from colorectal cancer: evaluation with postoperative follow-up results.
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Comparison of two methods of autologous intrasplenic hepatocellular transplantation in partially hepatectomized dogs.
Autologous hepatocellular transplantation using reflux into the spleen via the venous tributaries was compared in 65% hepatectomized dogs to direct injection into the splenic pulp. Transplantation into the spleen via the inferior terminal polar splenic vein led to a better survival rate (50 vs. 0%). Hepatocytes embolization to the intrahepatic portal vein system was observed. Although hepatocyte transplantation into the spleen can be accomplished either by direct punction of the spleen or by retrograde injection into a splenic vein, the second method decreases the frequency of cell embolization.
Ambulatory home total parenteral nutrition.
Ambulatory total parenteral nutrition (TPN) at home was used in 85 patients within a 6-yr period. Indications include severe malabsorption, fistulas, anorexia nervosa, and malignancies. The median duration of home TPN (HPN) was 67 days (range: 30-4,155 days). HPN duration for patients with benign diseases was longer [357.12 days (range: 30-4,155 days)] than for cancer patients [93.54 days (range: 30-421 days)]. Under HPN, patients gained a good nutritional status with an increase of total protein (p less than 0.001) and serum albumin levels (p less than 0.001). Weight gain was also significant (p less than 0.001). The rehospitalization rate was low (7.8%), but it was higher when HPN lasted for more than 3 months (10.87% +/- 1.58%) compared with short-term HPN (5.69% +/- 1.25%). Metabolic complications were unusual, and rehospitalization was related to the oncological treatment and/or infectious complications. Therefore, ambulatory HPN is a nutritional support that can significantly improve the life of patients with alimentary failure. Moreover, HPN allows significant cost savings compared to the alternative of prolonged hospitalization.
Home enteral nutrition system: one patient, one daily ration of an "all-in-one" sterile and modular formula in a single container.
A home enteral nutrition (HEN) system was introduced to deliver a day's ration of an "all-in-one" sterile and modular formula from a large container. The nutrient formula consisted of carbohydrate, protein, and lipid modules sterilized separately, in an autoclave at 120 degrees C, then mixed and supplemented with minerals and trace elements. Vitamins were given the patients through a feeding tube before connecting the nutrient container. The system was used to feed 12 malnourished patients (10 men and two women) with cancer (carcinoma of esophagus or tongue) or without cancer (esophageal perforation). All patients had normal gastrointestinal function but could not take in more than 500 kcal/day orally, because of their primary disease or the treatment for it (surgery in four patients; and radiotherapy, associated in some cases with chemotherapy, in eight). HEN duration ranged from 30 to 435 days at a daily cost of approximately US $15 to $20. Statistical analysis (Student's t-test for paired data) showed significant body weight gain (p less than 0.05) and significant increases in serum levels of albumin, transthyretin (p less than 0.05, respectively), and transferrin (p less than 0.01). Increases of serum total protein level were not statistically significant (p less than 0.09). The nutrient formula was well tolerated and there were no HEN-related rehospitalizations. Seventy-five % (nine of the patients) considered that HEN had improved their quality of life. The daily savings per patient, compared to the cost of treatment in a hospital, was about $260/day.(ABSTRACT TRUNCATED AT 250 WORDS)
Influence of N-acetylglutamine or glutamine infusion on plasma amino acid concentrations during the early phase of small-bowel adaptation in the dog.
Glutamine is a nonessential neutral amino acid that is widely consumed by the intestinal tract in catabolic states. We have followed up the plasma amino acid profile after extensive small-bowel resection in dogs receiving total parenteral nutrition (TPN) with or without glutamine (GLN) or N-acetylglutamine (aGLN) supplementation. Animals were divided into four groups according to the type of surgery (enterectomy or transection) and nutrition (TPN, TPN with aGLN, or TPN with GLN). Plasma GLN levels decreased in group I (enterectomy and TPN) on day 2 (p = .03) and significantly increased on postoperative days in groups III (enterectomy and TPN with aGLN) and IV (enterectomy and TPN with GLN). A significant increase of plasma GLN was observed in groups III and IV compared with group I on days 6 and 8 (p = .03 and p = .01). Plasma alanine decreased in groups with bowel resection, whereas no change was observed in the control group (transection) and the decrease of plasma alanine was significantly less pronounced in groups III and IV compared with group I. The increase of crypt depth and villous height was more pronounced in groups III and IV. These results suggest that GLN is a required substrate for mucosal growth and function, which could improve the intestinal adaptation encountered after enterectomy.
[Digestive insufficiency and artificial feeding. Theoretical and practical aspects (author's transl)].
The relatively new concept of digestive insufficiency was born as a result of prolonged artificial nutrition. Digestive insufficiency may be of organic, functional or mixed nature; its medical and surgical causes are numerous. Artificial nutrition has become a major therapeutic adjuvant in all types of digestive insufficiency. By acting as a substitute for the intestinal function, artificial nutrition permits better tolerance of specific treatments thanks to the nutritional rehabilitation and intestinal rest which it provides for as long as the patients' malnutrition and digestive lesions make it necessary.
Enteral nutrition in cancer patients: a new approach.
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Montpellier Cancer Institute strategy and experience in surgical treatment of multi-bilateral hepatic metastases from digestive tract cancers.
Montpellier Cancer Institute strategy and experience in surgical treatment of multi-bilateral hepatic metastases from digestive tract cancers is presented based on retrospective case by case analysis of survival time of 38 patients. The mean age was 46.2 years and the primaries were colorectal (22 patients) and endocrine (16 patients). Liver surgery was synchronous to the resection of primary lesions in 8 patients and metachronous in 22 patients. Two-step liver surgery was performed in 8 patients. Overall thirty-days postoperative mortality was 7.8% and morbidity 15.7% (wound sepsis, subphrenic abscess, transitory jaundice, biliary fistula). The analysis of survival time evidenced that with reasonable risk-benefit ratio the aggressive surgical approach can be justified especially in patients with endocrine primaries.
[Parenteral feeding in neoplastic diseases].
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Background and development of the All in One concept.
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[Treatment of epithelial cancer of the ovary. In favor of primary radical and regional surgery before chemotherapy and radiotherapy].
The treatment of epithelial carcinoma of the ovary (90% of malignant ovarian tumours) has largely benefited from chemotherapy, notably since the advent of cisplatinum. Radiotherapy may be an important adjuvant treatment to sterilize the pelvis. Both chemo- and radiotherapy are effective mainly on small residual diseases, hence the importance of initial surgery with maximal cell reduction, notably in carcinomas classified as stage III according to the International Gynaecology and Obstetrics Federation system. Regional surgery of the ovary must be pelvic and abdominal: from Douglas' pouch to the diaphragmatic domes. This therapeutic approach requires the resolution of two problems: intensive care and post-operative feeding. It has 2 major advantages: it avoids second-look operations or reduces their number, and it increases the survival rate at 5 years.
[Coralliform calculi. Apropos of 91 cases].
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[Conservative surgical treatment of rectal villous tumors].
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Technique of deep vein catheterization for prolonged total parenteral nutrition.
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[Computed gamma-tomographic estimation of a hepatic weight index during liver regeneration].
Single photon emission computed tomography was used to evaluate the total functioning liver mass and the regeneration process after partial hepatectomy. Serial tomographic sections were performed after infusion of 99m Technetium. In studies on dogs and in human beings, computed gammatomography enabled to calculate the liver mass with less than 10 p. 100 error. Hepatic regeneration was studied in 10 patients following resection of 46 to 84 p. 100 of the initial liver mass. The remaining liver mass increased rapidly postoperatively and doubled within 13 to 18 days. The regeneration process followed an exponential curve. Assessment of liver regeneration by this non-invasive technique should be of great help following partial hepatectomy.
[Comparative study of 3 portasystemic shunts following 65% hepatectomy in the dog. Evaluation of 2 specific functions of the liver].
Three types of porto-systemic shunt were performed in the dog following 65% hepatectomy with the aim of determining the best porto-systemic shunt for the maintenance of hepatic function during regeneration of the liver: terminolateral portocaval shunt, mesenterico-caval shunt and spleno-pancreatico-caval shunt. The hepatic functions studied were the hydroxylation of vitamin D and proaccelerin synthesis. These functions were unaffected by the mesenterico-caval shunt whilst they were depressed to the same extent by both other types of shunt.