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Biomedical subjects

J C Paris

Publications and source records attributed to J C Paris.

At least 91 records · Page 5Linked to original sources
PubMed1989

Parameters affecting laser palliation in patients with advanced digestive cancers.

Ninety-nine nonsurgical patients (group I) with esophagogastric cancer were referred to the laser center for palliation of dysphagia, and another 142 nonsurgical patients (group II) with a rectosigmoid cancer were referred for palliation of abnormal rectal discharge (125 patients) or occlusion (17 patients). The immediate success rate was 83% in group I and 90% in group II. Patients were retreated monthly. The average duration of palliation was 4.3 months +/- 0.5 (+/- standard error) in group I and 9.3 months +/- 0.95 in group II. Complication rate was 4% in group I and 3.4% in group II. Parameters affecting results were found only in group I. Factors that could negatively affect the immediate success rate included annular size of the tumor basis more than two thirds of the circumference, tumor localization at the upper third of the esophagus, and recurrence after a nonlaser treatment. The average duration of improvement after initial success was affected only by the circumferential extension.

Aged↗
PubMed1989

Laser palliation for rectosigmoid cancers.

Lasers are now used in the rectum an colon for treatment of vascular telangiectasia [1], and benign and malignant sessile tumours [2,3]. This paper will describe the results of a 7 years experience with treatment of sessile rectosigmoid cancers.

Adult↗
PubMed1989

Endoscopic laser treatment for rectosigmoid villous adenoma: factors affecting the results.

Endoscopic laser treatment is reported in 264 patients with benign rectosigmoid villous adenomas revealed by biopsy. Patients include 100 who had contraindications to surgery, 60 who had a tumor recurrence after a nonlaser treatment, 101 for whom surgical resection appeared to be too drastic for a tumor found benign on biopsy, and 3 who refused surgery. Two types of lasers were used: the Nd:YAG and the argon laser. In some patients, both lasers were used. Treatment was completed in 226 patients. Total tumor destruction was attained in 92% of them, a carcinoma was detected in 7% on biopsy specimens obtained during laser treatment, and benign villous tissue persisted in 1%. During the average 25.9-mo follow-up period of the patients with total tumor destruction, 13% had a tumor recurrence. Treatment was well-tolerated with no major complications. The circumferential extension of the tumor base was the only factor affecting the duration of treatment, and the rate of complications. The recurrence rate after initial treatment was higher in patients treated for a recurrence after a previous nonlaser treatment than in patients treated only by laser (p = 0.04). It was also higher when the initial histology was low-grade dysplasia than if it was high-grade dysplasia (p = 0.017) and when the tumor was located in the lower or middle rectum as opposed to the upper rectum or sigmoid (p = 0.04). We estimated that the direct cost of laser treatments was 28%-40% of the surgery charges for lesions of identical size in our hospital and 31%-69% at UCLA Center for the Health Sciences. Because treatment is long and difficult and the cancer rate is high, endoscopic laser for patients with a circumferential villous adenoma should be limited to nonsurgical candidates. The risk of a fatal complication after surgery has to be balanced against the risk of undetected carcinoma in the other patients and the indication for endoscopic laser treatment should be discussed case by case.

Adenoma↗
PubMed1989

Impaired bacterial flora in human excluded colon.

We compared the rectal microflora of 16 patients with surgically excluded colorectum with 16 healthy controls. The cause of diversion was inflammatory bowel disease (n = 10), colon cancer (n = 3), miscellaneous (n = 3). Six patients had a diversion colitis. In the excluded colorectum, the total bacterial count was only slightly lower than controls but the variety of the flora was significantly reduced. This reduction was confined to strict anaerobes, mainly the genus Eubacterium and Bifidobacterium. Among aerobes, enterobacteria were more often isolated than in controls. This altered microflora of excluded colorectum could be involved in the mucosal damage observed in some cases.

Adult↗
PubMed1989

Percutaneous transhepatic embolization of gastroesophageal varices: results in 400 patients.

During a 7-year period, bleeding esophageal varices were treated by means of percutaneous transhepatic embolization in 400 cirrhotic patients, including 258 patients with Child's class C cirrhosis (65%) and 142 patients with Child's class B cirrhosis (35%). Embolization was performed either with bucrylate or with absolute ethanol and stainless-steel coils. Variceal hemorrhage was controlled in 245 (83%) of the 297 patients in whom percutaneous transhepatic embolization was performed as an emergency treatment. The 10-day survival rate in the series was 76%, with 97 deaths occurring shortly after the procedure as a result of recurrent bleeding or liver failure. The actuarial rate of recurrent bleeding was 55% at 6 months (38% Child's class B, 70% Child's class C) and 81% at 2 years (71% Child's class B, 90% Child's class C). One-half the cases of recurrent bleeding were easily controlled by medical treatment; 56% of these patients were still alive at 6 months (79% Child's class B, 42% Child's class C), 48% were alive at 1 year, and 26% were alive at 5 years. Results indicated that the survival rate was significantly higher (p less than .01) in Child's class B patients than in Child's class C patients during the 5-year follow-up period. The overall technical failure and complication rates were 9% and 7%, respectively, but these rates declined progressively as we gained more experience with the procedure. In this large series, transhepatic embolization was a safe, easy-to-perform, and effective treatment for the control of variceal bleeding and was somewhat more efficacious than previously reported.

Adult↗
PubMed1989

Testing for course patterns in Crohn's disease using clustering analysis.

Using clustering analysis, we sought to identify groups of patients on the basis of the disease course among a population of 177 patients with Crohn's disease and followed for 3 years or more, starting from the first frank exacerbation of the disease. The first 36 values of a monthly clinical score represented the active variables of the clustering analysis. This method yielded 2 course groups, A and B, of 95 and 82 patients respectively. The unfavorable course in group A was characterized by the persistence of the clinically active disease at 3 years, whereas group B individuals achieved complete clinical remission within 2 years of onset on the average. Among the initially known clinical data which could explain the course, only the incidence of an occlusive syndrome was higher in group B, which showed a more favorable course. Although we applied clustering analysis to a patient sample over a period of only 3 years, our results do suggest the existence or 2 primary course groups within the population of patients with Crohn's disease. It would appear that the disease course cannot be predicted from the clinical parameters present at the time of onset, but rather becomes apparent during the course of the first 2 years.

Adult↗
PubMed1988

[Pharmacokinetics of cefotaxime in cirrhotic patients with or without ascites].

Pharmacokinetic values of cefotaxime were measured in 12 cirrhotic male patients (6 without ascites and 6 with ascites) after intravenous injection of a single 2 gram dose of the antibiotic. In patients without ascites elimination of the drug was about the same as in normal subjects or control patients, although clearance was increased. In patients with ascites, the drug elimination half-life was significantly more prolonged (7.5 +/- 3.9 h versus 1.3 +/- 0.4 h, P less than 0.01) and the drug clearance was significantly lower (193.6 +/- 92.4 ml/min versus 475.8 +/- 152.2 ml/min, P less than 0.01) than in the other group. The accumulation of cefotaxime in these patients produced concentration in the ascites fluid that were above the critical therapeutic values for about 20 hours.

Ascites↗
PubMed1988

Paraneoplastic intestinal pseudo-obstruction as the presenting feature of small-cell lung cancer.

A previously healthy 50-year old man presented with acute small bowel obstruction. No etiology was found at laparotomy. Postoperatively, the patient remained symptomatic with nausea, vomiting and severe constipation. Gastroscopy revealed retained food in the stomach. Gastric emptying of solids and liquids was dramatically decreased at scintigraphy. The colon was dilated on X-ray study. Chest X-ray revealed a pneumopathy and a small-cell lung cancer was discovered at bronchoscopy. The patient died 5 months after onset. Histologic study of the gut showed widespread degeneration of the myenteric plexus with plasma cell infiltration, Schwann cell proliferation and a reduced number of neurons of which many were abnormal. Intestinal pseudo-obstruction can reveal a small-cell lung cancer; the mechanism of neuronal impairment leading to pseudo-obstruction remains unknown, but could be related to the pathophysiology of paraneoplastic syndromes.

Carcinoma, Small Cell↗
PubMed1988

[Esophageal cancer and endoscopic sclerosis of esophageal varices: a fortuitous association?].

We report the case of 4 male patients, smokers, with alcoholic cirrhosis, mean age 54.7 +/- 6 years, treated by sclerotherapy for bleeding esophageal varices. Variceal eradication was obtained following juxtacardial intravariceal injection of 1.5 p. 100 polidocanol in one case (100 ml), and 0.5 p. 100 polidocanol in 3 cases (90, 240 and 310 ml). Local complications were observed in all patients (ulcers: 3; stenosis: 1). Carcinoma of the lower third of the esophagus was detected 12, 20, 22 and 30 months after esophageal sclerosis. Carcinoma was circular (one case), semicircular (2 cases), and nodular superimposed on Barrett's esophagus (one case). Histologic features included squamous cell carcinoma in 3 cases and adenocarcinoma in one case. Sclerotherapy could lead to the development of carcinoma because of mucosal alterations. However, other high risk factors (age, alcohol-tobacco intoxication, Barrett's esophagus) and different histologic features suggest a causal association. Endoscopic follow-up of patients after esophageal sclerosis could confirm this hypothesis.

Adenocarcinoma↗
PubMed1988

Eosinophilic gastroenteritis: ultrastructural evidence for a selective release of eosinophil major basic protein.

Ultrastructural study of mucosal eosinophils in a case of eosinophilic gastroenteritis involving stomach, duodenum and ileum showed an altered structure in ulcerated duodenal areas. The electron core density of eosinophil granules was inverted or disappeared and tubulovesicular structures occurred. Using immunogold staining with specific antibodies, major basic protein was detected diffusely in the matrix of eosinophil granules and out of the granules in tight association with extragranular membrane formations. In contrast, eosinophil cationic protein and eosinophil peroxidase were normally distributed in the granule matrix. When compared with the eosinophils in macroscopically normal duodenal mucosa in the same patient, these changes support a role for major basic protein in tissue damage in eosinophilic gastroenteritis. The diffusion of one granule protein from the granules to the exterior of the cells favours the view of a selective release of eosinophil mediators.

Adult↗