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Biomedical subjects

J Moreaux

Publications and source records attributed to J Moreaux.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Surgical treatment of common bile duct calculi. Results and outcome in a series of 707 cases].

From 1965 to 1990, 707 patients (22 p. cent aged between 70 and 80 and 6% over 80) were operated on for common bile duct (CBD) stones, with intraoperative cholangiography and endoscopic control of the duct patency since 1977. Before 1981, all patients were operated on (n = 546). After 1981, 161 patients were operated on, 30 had an endoscopic sphincterotomy (ES) and the operation was completed by an ES in 9 patients for retained stones voluntarly (n = 5) or unvoluntarly (n = 4). Before 1981, there were no postoperative deaths. One patient died during the anesthetic induction and was not operated on. After 1981, there were 3 deaths: no death after surgery, 1 after surgery + ES from acute cholangitis with multiple hepatic abscesses and 2 after ES in high risk patients. After 1981, there were no biliopancreatic postoperative complications. The incidence of operations for CBD stones has decreased in our series (400 between 1970 and 1979, 190 between 1980 and 1989) and the proportion between operations for CBD stones and operations for gallstones has decreased from 14% before 1981 to 8% after 1981. The declining of surgery is in relation to the increasing of ES. Many factors may influence the choice between surgery and ES: 1--age and general health problems, 2--complicated (jaundice, acute cholangitis, acute pancreatitis) or non complicated lithiasis, 3--gallbladder in situ with or without stones, or anterior cholecystectomy, 4--predictive difficulties for ES or for extraction of stones through ES, 5--predictive difficulties for surgery or extraction of stones through hepaticotomy, 6--experience of the endoscopic and surgical teams.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Extracorporeal lithotripsy in experimental vesicular lithiasis in pigs].

Experimental extracorporeal shock wave lithotripsy of gallstones was performed with the EDAP LT 01 piezoelectric lithotripter. Fragmentation of biliary stones was evaluated after implantation of human stones inside the gallbladder in 10 pigs. Lithotripsy was performed with a firing frequency of 2.5 shots per second during a mean time of 50 min. Zero to 18 days after lithotripsy, complete fragment clearance was seen in 6 cases, fragments less than 2 mm were found in 2 cases and fragments larger than 2 mm with only 1 non fragmented stone in 2 cases. There were no stone fragments in the cystic and common ducts. Damage to gallbladder and adjacent organs was appreciated after lithotripsy to the empty gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. Perforation of the gallbladder was observed in both pigs treated with a firing frequency of 40 shots per second and in 1 pig out of 3 treated with a firing frequency of 20 shots per second. With 10 shots per second and lower firing frequencies, mild histological changes of the gallbladder walls were only observed in 3 cases reoperated on the 2nd day after lithotripsy. The gallbladder wall was normal in the 5 cases reoperated on the 15th day and there were no hepatic, duodenal and pancreatic lesions. These experimental results are consistent with utilization of this machine in the treatment of gallstones in man; low firing frequencies are effective for fragmentation of gallstones without any adverse effects.

Animals↗
PubMed1990

[Is extracorporeal lithotripsy in appendicular lithiasis an alternative to cholecystectomy?].

This study was done with the EDAP LT 01 piezoelectric lithotripter. Experimental fragmentation of biliary stones was evaluated in vitro and in vivo after implantation of human stones inside the gallbladder of pigs. Tissue damage was appreciated after application of ESWL to the gallbladder of pigs with firing frequencies from 40 to 1.25 shots per second. 125 patients were treated in our centre since 1987. Duration of the session was about one hour, without any anaesthesia or analgesia. The patients are no more hospitalised. An other session was necessary in case of unsatisfactory fragmentation. All the patients were treated by adjuvant dissolving agents. The results are in course of evaluation. Fragmentation of gallstones is obtained in 80 to 99% of the patients. Side effects are rarely observed and there was no case of acute pancreatitis in this series. With the Dornier machine, a complete stone clearance was obtained in 80% of the patients after one year and 93% after two years but there was a 10% rate of gallstones recurrence after one year of clearance. Place of ESWL for gallstones in the future needs to be carefully assessed.

Animals↗
PubMed1989

[Cancer of the gallbladder. A surgical experience].

Between 1965 and 1987, carcinoma of the gallbladder was found in 65 patients, 59 of whom were operated upon. Seventy-seven per cent of these patients were women. Mean age was 68 years. Cholelithiasis was present in 77 per cent of the patients. Since 1977, the preoperative diagnosis was made by ultrasonography in 43 per cent of the cases. The overall actuarial 1-year, 5-year and 10-year survival rates were 30, 13 and 13 per cent respectively. For patients whose tumour was limited to the gallbladder wall (Tis, T1, T2), the actuarial 5-year survival rate was 73 per cent. For patients with T3 and T4 tumour, the 2-year survival rate was nil. The resection rate with "curative aim" was 25 per cent, but recurrences occurred in 3 patients (2 T2, 1 T3) out of 11 after cholecystectomy and in 4 patients (1 T2, 3 T3) out of 5 after cholecystectomy and wedge resection of the liver at gallbladder fossa level with regional lymph node dissection. No major hepatic resection was performed. The prognosis mainly depended on the tumoral extension in depth. For the early stages, the survival rate could be higher with a more aggressive surgical procedure. For the usually observed tumours which extend beyond the gallbladder wall, the prognosis has not been improved.

Actuarial Analysis↗
PubMed1989

[Cancer of the colon. Survival and prognosis after surgical treatment in a series of 1000 patients].

During the last 20 years, 1,000 patients were operated on for a single cancer of the colon, 497 men and 503 women (mean age: 67 years). Resection was performed in 93% of the patients and resection with curative intent in 80% of the patients. Carcinomas located on the left colon were usually treated by segmental resection. There were 8 postoperative deaths, 4 of them after curative resection. The crude 5-year survival rate established from the 754 patients operated on before 1984, with a follow up for all of them except 5, was 60% after all operations and 76% after curative resection. Prognosis was not influenced by tumor site and time elapsed between first symptom and operation. The 5-year survival rate was higher in female patients and in patients less than 50 years. Tumor staging was the main prognostic factor. Based on Dukes' classification, the 5-year survival rate for A, B, C, D tumors was 90%, 78%, 56% and 5% respectively.

Aged↗
PubMed1988

[Radiotherapy before amputation of the rectum for cancer. 100 cases].

Between 1977 and 1982, 100 patients were treated with pelvic irradiation of 3000 rads given over a 3-week period for a carcinoma located in the lower third (51 cases) or the middle third (49 cases) of the rectum. The irradiation was well tolerated by all patients. The tumour disappeared in 4 patients who were not operated upon and survived for more than 5 years. Among the remaining 96 patients, 18 of whom had fixed lesions, rectal excision was performed in 87 (90.6 per cent) and was considered curative in 75 (78 per cent). Pathological examination of the surgical specimens revealed the absence of tumour in 4 cases. There were 2 post-operative deaths. After curative excision, the 5-year survival rate was 70 per cent and the locoregional recurrence rate was 8 per cent, with perineal recurrence in only one case. Patients treated with pre-operative irradiation have been compared with a historical series of patients who had abdominoperineal excision without irradiation. In the present series of irradiated patients, thromboembolic complications were more severe, and the problems encountered with healing of the perineum were solved by changing the surgical technique in order to close the perineal wound. The rectal tumours were smaller, with a smaller proportion of tumours of more than 5 cm in diameter (P less than 0.001), but there was no significant change in Duke's stage distribution. The 5-year survival rate was higher (70 per cent versus 55.3 per cent; P less than 0.05), and the 5-year locoregional recurrence rate was lower (8 per cent versus 18.4 per cent; P less than 0.05).

Adenocarcinoma↗
PubMed1985

[Colonic cancers. Results of surgical treatment and prognosis. 579 cases].

Between 1964 and 1981, 579 patients were operated upon for carcinoma of the colon. Hepatic and/or peritoneal metastases were present in 17.3%. Excision was performed in 530 cases (91.5%). Carcinomas of the left colon were usually treated by segmental resection. The peritoneum and lymph nodes were involved in 21.7% and 31% respectively of the patients who underwent resection. There were 6 post-operative deaths: 2 after exploratory or derivative surgery and 4 after excision of the tumour. All but 8 of the 395 patients operated upon before 1978 were followed up; 229 survived for more than 5 years, 58% of all operated patients and 63.6% of those who had their tumour excised. The 5-year survival rate was 6% after palliative excision and 73.6% after curative excision (caecum and ascending colon: 81%; transverse colon: 83%; descending colon: 65%; sigmoid flexure: 70.7%). Tumoral invasion in depth and lymph node involvement had a significant influence on prognosis. Based on Dukes' classification, the 5-year survival rates for stages A, B, C and D tumours were 89%, 75.4%, 54% and 6% respectively. The time elapsed between the first symptoms and the operation did not alter the prognosis which was slightly better in women and in young patients.

Adult↗
PubMed1985

[Multiple cancers of the colon and rectum. Incidence and results of surgical treatment].

Out of 1,528 patients operated upon for cancer of the colon or rectum between 1964 and 1984, synchronous carcinomas were observed in 63 patients, metachronous carcinomas in 36 patients and both synchronous and metachronous carcinomas, in 3 patients. Synchronous carcinomas were double in 59 patients and triple in 4 patients. In 80 p. 100 of the cases, the lesions were confined to the same surgical segment or to an adjacent segment. Rectal locations were less frequent (18 p. 100). Preoperative diagnosis was made in only 40 p. 100 of cases. Ninety-three p. 100 had resection, 81 p. 100 with a curative intent. Associated benign polyps were found on the resected specimen in 58 p. 100 of the cases. The resectability rate (93 p. 100) and 5-year survival rate (55 p. 100 of all operated patients and 67 p. 100 of those who underwent curative resection) were similar to those observed in our personal series of single carcinomas of the colon. A second cancer of the colon or rectum occurred in 36 patients. The time interval between the first and second carcinomas ranged from 1 to 24 years and the mean interval time was 6.3 years. Three of the 36 patients developed a third metachronous lesion. The distribution of the sites of successive carcinomas was similar to that of synchronous carcinomas; the second carcinoma was located in the rectum in 8 p. 100 of cases. Diagnosis of the second carcinoma was made through routine periodic colonoscopy in one third of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Obliteration of the pelvic space with pedicled omentum after excision of the rectum for cancer.

From 1979 through 1982, removal of the rectum for cancer in 67 patients (50 of whom underwent preoperative radiotherapy) was completed by obliteration of the resulting dead space with pedicled omentum. No complication could be related to the method. After abdominoperineal resection (54 patients), primary healing of the perineal wound was achieved in 77 percent of the patients (85 percent during the last 2 years), and the mean postoperative hospital stay was 22 days. Minor perineal suppuration occurred in 10 patients with a 40 day average time of healing, and major suppuration occurred in 1 patient only with a 3 month time of healing. After the extended Hartmann operation (12 patients), no pelvic abscess was observed and the median hospitalization stay was 19 days. Pelvic filling in the management of patients undergoing rectal excision is an adjunctive procedure that is mainly intended to provide a better postoperative course. It might also facilitate postoperative radiotherapy.

Adenocarcinoma↗
PubMed1984

[Results of the surgical treatment of pancreatic cancer. Study of a series of 96 surgically treated patients].

From 1970 to 1980, 96 patients were operated on for pancreatic adenocarcinoma. Histological confirmation was obtained in all but 12 cases. The tumour was located in the right portion of the pancreas in 80 cases and in the left portion in 16 cases. Metastases were present in 39 patients, hepatic in 28 cases and peritoneal in 23 cases. Among the cases without metastasis, lymph node involvement was found in 12 patients out of 25. A partial pancreatectomy was carried out in 12 patients, by-pass operations in 50 patients and laparotomy only in 34 patients. The 30-day postoperative mortality rate was 12 p. 100 in the by-pass group; there was no postoperative death in the resected group. By 1982, all the patients were dead. The mean length of survival after Whipple resection was 15.6 months, after by-pass operations 8 months, after laparotomy 3.4 months, operative mortality excluded. When lymph nodes were involved (stage III), the mean duration of survival after resection (n = 4) was the same (i.e. 7,5 months) as that after by-pass operations. The period of survival after by-pass procedures only exceeded one year in 8 cases. After pancreatic resection, only one patient survived five years. These results show that the resectability rate of pancreatic carcinoma is very low. Pancreatic resection seems to be justified mainly in stage I and II tumors. However, prognosis of pancreatic carcinoma remains very poor and the 5-year survival rate after resection does not exceed 10 p. 100.

Adenocarcinoma↗