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J Marescaux

Publications and source records attributed to J Marescaux.

At least 19 recordsLinked to original sources
PubMed1996

Laparoscopic right and left adrenalectomies. Surgical procedures.

BACKGROUND: Laparoscopic approach for adrenalectomy was recently described and the operative technique is not yet well defined. METHODS: Twenty-seven laparoscopic adrenalectomies were performed between 1992 and 1995. There were 18 women and nine men ranging in age from 31 to 70 years (mean, 50.8 years). The surgical procedure was a lateral decubitus transperitoneal flank approach in 26 patients, and a retroperitoneal approach in one. Twelve right and 15 left glands were removed. Adrenal diseases were primary aldosteronism in 20 patients, nonfunctional adenoma in four patients, Cushing adenoma in two, and an adrenal cyst in one. Median adrenal gland size was 2.0 cm (range 0.5-8 cm). RESULTS: Five patients were converted to laparotomy (18%)-for dissection problems in four and for an unrecognized gland in one. The median anesthesia time was 200 min and the median surgical time was 140 min. Operative morbidity was one adrenal vein injury sectioned close to the vena cava. The hemorrhage was controlled by laparoscopic suturing without conversion. This patient required a three-unit blood transfusion. No mortality occurred and postoperative morbidity was one minor chest infection. The median postoperative in-hospital stay was 4.6 days (range 2-8) for nonconverted patients. CONCLUSIONS: Laparoscopic adrenal gland removal is safe and offers fast recovery and short in-hospital stay. Laparoscopic adrenalectomy combines the advantages of both the conventional anterior and posterior approach.

Adenoma↗
PubMed1996

Biomaterial supports for colonic wall defect healing. An experimental study in the rat.

New artificial biomaterials were tested for support of gastro-intestinal tract wound healing in the rat. Double layered collagenic matrices were prepared with purified collagens extracted from human placental tissues. Two types of patches were tested, the first constituted from a collagen type I + III layer covered by collagen IV in a liquid phase (patch I + III/IV) and the second from a collagen IV layer covered by liquid collagen IV (patch IV/IV). The matrices were applied with fibrin sealant to the edges of a 1 cm diameter colonic wall defect in the rat. Healing evolution was determined by macroscopic, microscopic and immunostaining studies. The reconstitution of the three colonic wall layers was achieved within 45 days without retraction or inflammatory reaction, while the biomaterial was resorbed. Human collagen I and III antibodies failed to stain extracellular matrix. This failure may be a consequence of outdated antibodies or more likely epitope alteration during extraction and preparation of the collagens. A human collagen type IV antibody staining of the scar zone showed the basement membranes of newly developed vessels within 10 days, and newly formed colonic mucosa within 20 days. The collagen reconstituted matrix was able to assist healing of normal digestive tract defects as shown by the labelling of the new synthesized extracellular matrix by collagen type IV antibody. These findings support the use of collagen biomaterial in gastro-intestinal anastomosis. This new surgical approach allowing healing of colonic wall defects could reduce occurrence of anastomotic leakage in human.

Animals↗
PubMed1996

Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study.

BACKGROUND: Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with right iliac fossa pain. However, the precise role of laparoscopic appendectomy in men is unclear, and this study was therefore undertaken to examine this specific issue in a prospective randomized trial. METHODS: One hundred men between the ages of 16 and 65 years who had suspected appendicitis were recruited and randomized to undergo either open or laparoscopic appendectomy. Both groups were compared in terms of their clinical parameters, duration of anesthetic and operation times, postoperative pain, duration of ileus, and length of hospital stay. RESULTS: The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes versus 25 minutes) compared with open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no significant difference was seen between the laparoscopic and open appendectomy groups in the recovery of bowel function (24.7 hours versus 21 hours) and in the length of hospital stay (4.9 days versus 5.3 days). CONCLUSIONS: The results of this prospective randomized trial showed that there were no significant advantages of laparoscopic appendectomy over open appendectomy for the treatment of male patients with suspected appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients.

Adolescent↗
PubMed1996

Photodynamic imaging of a rat pancreatic cancer with pheophorbide a.

Laser-induced fluorescence of pheophorbide a (Ph-a) was used for in vitro photodynamic imaging (PDI) of a rat pancreatic acinar tumor. A 400 nm excitation induced a 470 nm autofluorescence and a 678 nm dye fluorescence in tumors and their surrounding pancreas 24 h after a 9 mg kg-1 body weight Ph-a intravenous administration. With lower intensities in these blood-rich tumors than in pancreas, Ph-a fluorescence signals are unable to provide tumor images. A dimensionless function (the ratio of Ph-a fluorescence by autofluorescence, called Rt for the tumor and Rp for the pancreas) was used for fluorescence contrast calculation (C = Rt/Rp) between six tumors and their paired pancreas. Among five available laser excitation wave-lengths, only the 355 nm excitation gave a distinctive contrast (C = 1.5). The PDI of six intrapancreatic tumors and their intraperitoneal metastasis and of two control normal pancreas was thus performed ex vivo using a 355 nm excitation source delivered by a tripled Nd:YAG laser and a charged-coupled device camera. Fluorescence images were recorded at 680 nm (dye), 640 nm (background) and 470 nm (autofluorescence) through three corresponding 10 nm width bandpass filters. Computed division for each pixel of Ph-a fluorescence values by autofluorescence generated false color image. In this way, contrasted tumor images were obtained. But in five out of six animals false-positive images were present due to an autofluorescence decrease in some normal pancreatic areas. A 470 nm autofluorescence imaging on the same tumors gave in all cases false-positive image and false-negative in half of the cases. These observations suggest that autofluorescence alone is unable to achieve accurate PDI of pancreatic carcinoma and that using Ph-a as a PDI dye needs strong improvements.

Animals↗
PubMed1996

Biomaterials for primary closure of a choledochotomy in dogs.

Since primary closure of the common bile duct is often not undertaken because of the risks of biliary leakage and peritonitis, we have evaluated feasibility and reliability of closure using biomaterials. In three groups of dogs, an unsutured choledochotomy was closed with circular glued patches: a scleroprotein patch in 4 dogs and an oxidized, compressed human collagen patch reinforced (n = 6) or not (n = 6) with three stitches. The scleroprotein patch (n = 4) was resorbed too soon, and in 2 dogs the unstitched collagen patches became unglued; biliary leakage was the result in both instances. The bile duct healed successfully within 1 month in the other 10 animals fitted with collagen patches, despite one common bile duct stricture. Safe primary closure of a choledochotomy may be envisioned in humans if the duct suture is protected by this new collagen biomaterial.

Animals↗
PubMed1995

[Colonic diverticular haemorrhage].

Bleeding related to diverticular disease occurs in 10 to 30% of patients suffering from diverticular disease. Haemorrhage varies from occult to massive bleeding. Bleeding is related to mechanical aggression of the artery in the wall of a diverticulum. Bleeding prevalence is not exactly known. In 1 to 7% of cases, massive bleeding is observed; diverticular disease is thus the most common cause of major lower gastrointestinal tract haemorrhage, followed by angiodysplasias. Although 95% of diverticular involve the sigmoid colon, more than 50% of bleeding diverticular occur in the right colon. Classically, presentation of bleeding is sudden without any inflammatory diverticulitis. Bleeding from diverticula stops spontaneously in 80% of cases. For definite diagnosis, selective abdominal angiography during bleeding phase is the procedure of choice. Other explorations are not contributive. Most haemorrhages have a benign outcome. Massive, persistent or recurrent haemorrhage should benefit from surgical procedure. In case of active bleeding in which diverticular origin has been validated by angiography, intra-arterial perfusion of vasopressor agents may be attempted, as a temporary treatment before delayed colonic resection. Segmental colectomy usually prevents recurrent haemorrhage when site of diverticular bleeding has not been identified with precision by angiography. Subtotal colectomy should only be used in the last resort. Extent of surgery will be based on likely origin of bleeding.

Diverticulum, Colon↗
PubMed1994

Experimental pancreatic cancer in the rat treated by photodynamic therapy.

Selective histological necrosis of experimental pancreatic carcinoma by photodynamic therapy (PDT) has been successful with haematoporphyrin derivatives and phthalocyanine as photosensitizers. This report describes the feasibility of PDT with pheophorbide A as the photosensitizer to treat azaserine-induced pancreatic rat carcinoma and analyses survival of the animals. An organ distribution study 24 h after pheophorbide A administration (9 mg/kg intravenously) gave a selectivity ratio of 13.5:1 between tumour and surrounding tissue. Light of 660 nm and 100 J/cm2 induced selective necrosis of the tumour. Six of nine rats were cured in 120 days whereas all 36 control animals died within 35 days (P < 0.01). The pancrease and hepatic pedicle were relatively unaffected by PDT, but the duodenum was injured.

Adenocarcinoma↗
PubMed1994

Laparoscopy: an alternative to surgery in patients treated with continuous ambulatory peritoneal dialysis.

Fifteen laparoscopic abdominal operations were performed in 14 patients treated by continuous ambulatory peritoneal dialysis for chronic renal failure. Celioscopic exploration of the abdomen and subsequent operation displayed several advantages specific to the method: identification of the etiology of scrotal dialysate outflow was achieved in 4 cases, peritoneal dialysis catheter salvage during laparoscopic cholecystectomy in 1 case, abdominal exploration during occurrence of peritonitis in 3 cases, and catheter dysfunction or abdominal examination before catheter implantation in 7 cases. The laparoscopic procedure allows early resumption of peritoneal dialysis after surgery, hence avoiding the need for transient hemodialysis. Nevertheless, it seemed unable to offer a salvage capability of infected catheters through extensive abdominal washing. Laparoscopy has been reported to decrease postoperative pain and disorders of ventilation, allowing for rapid recovery of social and professional activities following this minimal invasive surgical technique. Laparoscopy is a novel technique which enables precise diagnosis and surgical operations in patients treated by continuous ambulatory peritoneal dialysis.

Abdomen↗
PubMed1994

Implication of cholecystokinin in pancreatic adaptation after biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), a bariatric surgical procedure, leads to a malnutrition-induced general visceral atrophy except for the pancreas. This work investigates the implication of cholecystokinin (CCK) in the exocrine pancreatic adaptive process using a plasma CCK assay and the CCK receptor antagonist CR 1409. No significant reduction in weight and DNA content of the pancreas was noted 36 days after BPB, while a strong decrease in protein, enzymes and RNA contents indicating cellular hypotrophy became apparent. CR 1409 treatment strongly depressed pancreatic weight and its DNA content in BPB animals, suggesting an additional hypoplasia; however, the reduction in pancreatic enzyme content was not aggravated. BPB increased plasma CCK concentrations by 160%, unrelated to CR 1409 treatment. These results indicate that: (1) CCK is involved in the pancreatic adaptive response after BPB in rats, and (2) in the context of a protein malnutrition state, CCK dissociates its pancreatic growth and enzymatic effects, favouring the former.

Adaptation, Physiological↗
PubMed1994

[Implantable insulin pump: the first step towards an artificial pancreas].

Recent improvements in miniaturization of implantable pumps and the ability of their control by teletransmission allow implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient has died to date. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them leading to final pump explantation. Mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin assays were all lower versus pre-implantation assays. A statistically significant difference was demonstrated regarding mean global blood-sugar. The frequency of severe hypoglycemia incidents (2 in our series) and biochemical hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing a major benefit of the technique. The patients well-being and quality of life were notably improved. Implantable insulin-pump may be offered as alternative treatment to conventional insulin-therapy, especially in cases of diabetes which are difficult to control and particularly in cases with frequent hypoglycemic malaise.

Adult↗
PubMed1994

[Primary leiomyosarcoma of the femoral vein. Therapeutic aspects].

Leiomyosarcomas are exceptional in peripheral veins. Clinical signs are not specific, secondary to effects of the tumoural mass. Computed tomography and MRI give a precise topographic diagnosis. Pathology examination on biopsy or surgical specimens establishes the histological diagnosis. Therapeutic management must take into account local tumour recurrence and metastasis. Surgical exeresis should be wider than the tumour's pseudocapsule to include micrometastases neighbouring the primary tumour. Post-operative radiotherapy (55 to 70 Gy) and chemotherapy should follow. With this management scheme, local disease is controlled in 85% of the cases with a 5-year follow-up. Local or metastatic extension usually occurs within the first 3 years. Management of venous sarcomas thus requires a multidisciplinary cooperation between the surgeon, the radiotherapists and the chemotherapist.

Adult↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗
PubMed1993

Intra-abdominal photodynamic therapy: from theory to feasibility.

Photodynamic therapy is a new anticancer technique, directed at the selective destruction of neoplastic tissue, which has been used in the treatment of superficial or intraluminal lesions. The technique has now reached the stage where it can be considered in the peroperative management of gastrointestinal tumours, for example in an attempt to eradicate micrometastases in the tissue around the primary tumour or in residual lymph nodes after curative resection. Many practical problems remain to be solved, such as the pharmacokinetics of photosensitizers, the dosimetry of illumination and the sensitivity of intra-abdominal organs. An experimental and clinical evaluation is in progress to assess the feasibility of photodynamic therapy in surgical practice.

Abdominal Neoplasms↗