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J Mouiel

Publications and source records attributed to J Mouiel.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Course of the recurrence of hepatitis C virus infection after liver transplantation].

OBJECTIVES: Hepatitis C virus recurrence is frequent after orthotopic liver transplantation. The aim of this study was to evaluate the clinical, biological, and histological characteristics of recurrence. METHODS: One hundred and ten patients (91 males, mean age 49 years) with liver transplantation were followed up for more than 1 year (mean: 26 months, range: 12-71). Hepatitis C virus serologic 2nd generation tests were performed before and every 3 months after transplantation in all patients. Serum RNA was detected every 6 months after transplantation by polymerase chain reaction. A percutaneous liver biopsy was performed every year in all patients and in case of abnormal biological liver tests. RESULTS: In 44 patients (40%), hepatitis C virus serology was positive before transplantation, and was unchanged after transplantation. In this group histologic chronic hepatitis was observed in 35 patients (79.5%). The mean Knodell score was 8.4 +/- 2.3, associated with an increase in serum aminotransferases (> twice the upper limit of normal) in 26 cases (74.3%) and with serum RNA in 33 cases (94.3%). The Knodell score was not significantly higher 2 years or more after transplantation than before (9.5 +/- 3.9 vs 7.2 +/- 3.5). In 66 patients with negative hepatitis C virus serology before transplantation, no changes were noted after transplantation. In this group, histologic chronic hepatitis was found in 14 cases (21.2%) associated with serum hepatitis C virus RNA in 7 cases. Actuarial survival rates of the two groups were 97.1% and 91.2% at 2 years, and 93.5% and 86.7% at 5 years, respectively. No death clearly related to hepatitis C virus recurrence was observed. CONCLUSION: Hepatitis C virus recurrence after liver transplantation is frequently associated with chronic hepatitis, and a progressive increase in liver lesions. Nevertheless, the 5-year survival rates was not different in these patients compared to patients with negative hepatitis C virus serology before transplantation.

Adult↗
PubMed1996

[Laparoscopic treatment of appendiceal peritonitis in adults].

UNLABELLED: The aim of this study was to evaluate the results of laparoscopic treatment of appendicular peritonitis. PATIENTS AND METHODS: From January 1991 to December 1994, 32 patients (16 men and 16 women with a mean age of 43 years) underwent emergency laparoscopy for a clinical diagnosis of localized or generalized appendicular peritonitis. All patients had double antibiotic therapy for at least 7 days. The laparoscopic appendectomy technique consisted of:insufflation to 12 mmHg, introduction of 3 trocars, first peritoneal lavage, coagulation of the mesoappendix, ligature of the base of the appendix, no drainage. RESULTS: There were 4 conversions (12.5%). Nine of the 28 cases treated completely by laparoscopy, presented generalized peritonitis and 19 presented localized peritonitis (including 8 abscesses). The operations were performed by 7 surgeons and the mean operating time was 86 minutes. There were no deaths. The postoperative morbidity was 10.7%. The mean duration of postoperative ileus was 2.8 days. The mean hospital stay was 6.8 days. Histological examination concluded on acute suppurative appendicitis 96.4% of cases. There were no bowel obstructions or incisional hernias with a mean followup of 28.5 months. CONCLUSIONS: The laparoscopic treatment of appendicular peritonitis is possible, simple and reproducible, effective, without any specific complications. The advantages of laparoscopic techniques over the traditional large incisions are the absence of parietal complications, the quality of exploration and peritoneal lavage, and improvement of postoperative comfort.

Adolescent↗
PubMed1995

Port-Site Recurrence of Cancer Associated With Laparoscopic Diagnosis and Resection: The European Experience.

Port-site recurrences of cancer have drawn attention to the potential risks of laparoscopy for the diagnosis and treatment of digestive cancers. The first observations concerned unsuspected gallbladder cancers shown by laparoscopic cholecystectomy for lithiasis. Seventeen cases in patients with advanced or early colon cancer followed. It eventually became clear that all cancers could be the origin of such recurrences, which present as apparently isolated nodules embedded in the wall. These parietal recurrences were well known in open surgery, having been reported for most cancers, but they drew little attention because they usually occur in the context of carcinosis. It must be remembered that digestive cancers in general have a high potential for dissemination and that nearly 30% of patients have micrometastases in the bloodstream, the lymph nodes, the peritoneum, or even the bone marrow. The mechanism of tumor implantation is analogous to development of an inflammatory reaction. Under these conditions, laparoscopic surgery is susceptible to cause neoplastic dissemination for a number of mechanical reasons: CO2 insufflation, tumor manipulation, failure to isolate the tumor, forceful extraction of the surgical specimen, and exsufflation. Multiinstitutional trials of well-defined laparoscopic protocols based on the same oncologic principles as in open surgery should reduce the frequency of tumor cell dissemination and the incidence of port-site recurrences.

Journal Article↗
PubMed1995

[Surgical treatment of benign hepatic tumors. A safe and efficient choice].

Benign liver tumors often require surgical treatment because of the diagnostic difficulties of their nature and because of annoying symptoms. With the aim of assessing if surgery is a safe therapeutic option we reviewed the data concerning 36 consecutive patients who underwent hepatic resection during the period January 1988-January 1993 at our Institution for 42 presumed benign liver tumors. Patients had a preoperative assessment consisting of biochemical tests, abdominal echography and contrast-enhanced scan in all cases, magnetic resonance imaging in 6 cases, celiacmesenteric angiography in 14 cases and percutaneous liver biopsy in 5 cases. We realised 5 major hepatectomies and 31 minor resections. There was no perioperative mortality. The postoperative complication rate was 5.5%. Mean hospital stay was 15.1 days (range 5-35 days). On follow-up, ranging from 4 to 60 months (mean 24 months), all patients are alive, without recurrence and free of symptoms. Histologic examination of specimens showed cavernous hemangioma in 20 cases, focal nodular hyperplasia in 19 cases and hepatic adenoma in 3 cases. Histologic findings were in accord with preoperative diagnosis in 57.9% of cases of cavernous hemangioma, in 42.8% of cases of focal nodular hyperplasia and in no case of hepatic adenoma. Our experience confirms that accurate preoperative diagnosis of presumed benign liver tumors is difficult in spite of complete radiologic investigations and liver biopsy. For this reason and for the risk of dangerous complications, such as malignant transformation and intraperitoneal hemorrhage, we believe that surgery is the treatment of choice in the majority of cases. This attitude, when realised in a center with experience in hepato-biliary surgery and using modern technical features is safe and efficient.

Adolescent↗
PubMed1995

[Teaching digestive laparoscopic surgery in France: from education to accreditation?].

The extremely rapid development of laparoscopic surgery since 1989 has given evidence, by the increase in the number of local and vital complications, that teaching of laparoscopic surgery is absolutely necessary, especially technical and practical training. Indeed, laparoscopic surgery is not only a new and different way to attain abdominal organs, but it needs also a complete different acquiring of gestures, which are difficult since the eyes and hands are dissociated due to the videotechnics. The University post-graduate training courses (University Diploma D.U.), which were first organized by the authors in Paris and Nice since 1990, have given the best answers to this challenge: training a large number of surgeons in a minimum of time. In 1994, a new Collège of general visceral and digestive surgeons was founded and the teaching conditions have been modified since. This college courses of general and digestive surgery (D.E.S and D.E.S.C respectively) and during post-graduate formation (F.M.C). After having given recommendations for the program of theoretical and practical teaching of laparoscopic surgery, the authors suggest that this teaching should be integrated in graduate courses of general surgery and in post-graduate courses. These courses represent the best training and are the guarantee of good quality and it would be a big error to suppress them. They should continue under the constant control of the French College of Digestive Surgeons and be supervised by the French National order of medical Doctors.

Accreditation↗
PubMed1994

[Surgical treatment of gangrene of the perineum].

Acute perineal gangrene due to anaerobic Gram negative bacilli or streptococci rapidly leads to tissue necrosis and death in 50% of the cases despite progress in intensive care. Emergency treatment requires adapted antibiotics, hyperbaric oxygen therapy and repeated surgery. Factors of poor prognosis include age over 60 years, lomboabdominal or crural extension, septic shock, positive blood cultures and lack of fecal derivation. Surgery is performed under general anaesthesia since loco-regional anaesthesia is contraindicated during the septic phase. Repeated operations are needed to make large incisions, evacuate pus, search for foreign bodies and resect damaged tissue in order to expose all the infected areas to air and hyperbaric oxygen. A colostomy must be performed in order to avoid fistulization and contamination of the infected areas. An indwelling urine catheter is usually sufficient although a suprapubic catheter may be needed at the risk of further extension of the gangrene. Surgical treatment is associated with intensive care and hyperbaric oxygen therapy. Three effective antibiotics are recommended. Using this aggressive surgical protocol, we have been able to reduce mortality to 20% in patients under 60 years of age.

Combined Modality Therapy↗
PubMed1994

Laparoscopic Posterior Truncal Vagotomy and Anterior Seromyotomy.

For patients with peptic ulcer disease who only require acid reduction, laparoscopic procedures such as posterior truncal vagotomy and anterior seromyotomy can be offered. Elective surgery after a complete physiological workup can improve the results for a certain group of patients. The experiences with the Taylor procedure in open surgery promise the interest of gastroenterologists to include elective surgery among the therapeutic options. As experienced with other procedures, a minimally invasive approach will increase patients' acceptance of surgical treatment.

Journal Article↗
PubMed1994

Role of non-parenchymal liver cells in ischaemia-reperfusion liver injury: protective effects of muramyl dipeptide.

It has been suggested that non-parenchymal liver cells play a central role after ischaemia and reperfusion of the liver. Male Lewis rats were subjected to 90 min of warm liver ischaemia. Four groups were constituted: group 1, no treatment; group 2, muramyl dipeptide treatment, activation of Kupffer cells; group 3, dextran sulphate injection, Kupffer cell blockade; and group 4, gadolinium chloride administration, Kupffer cell blockade. Dextran sulphate (4 mg/100 g) and gadolinium chloride (GdCl2, 0.7 mg/100 g) were given intravenously on day 2. MDP was injected intravenously (500 mg/250 g) 24 h before and 10 min after the intervention. Mortality rates were assessed and serum transaminases, histology of the liver and Kupffer cell phagocytic activity were evaluated 6 h after the end of ischaemia. MDP treatment significantly (P < 0.001) reduced mortality (30%) in comparison with the non-treated group (60%). The mortality rate was significantly higher in the dextran sulphate-treated (80%) and gadolinium chloride-treated (90%) groups in comparison with group 1. A significant reduction in transaminase levels was observed after MDP treatment, while blockade of Kupffer cells resulted in higher serum transaminase levels. The extent of necrosis and congestion was improved by MDP administration, while disruption of the vascular and sinusoidal integrity of the liver and extensive areas of necrosis were observed in dextran sulphate and gadolinium chloride-treated rats. Sheep red blood cell 51Cr liver uptake was deeply depressed 6 h after the end of ischaemia in group 1 (10 +/- 1.2%/g tissue). MDP injection restored the Kupffer cell activity (30.6 +/- 3.22%/g tissue) while dextran sulphate and gadolinium chloride administration markedly decreased SRBC 51Cr liver uptake. Our findings demonstrate that MDP in able to protect the liver from ischaemic insult while blockade of Kupffer cells was deleterious in rats subjected to liver ischaemia.

Acetylmuramyl-Alanyl-Isoglutamine↗
PubMed1994

Recurrence of hepatitis C virus after liver transplantation.

The hepatitis C virus is a common cause of chronic hepatitis after orthotopic liver transplantation (OLT). We evaluated 95 consecutive patients who underwent OLT at our institute between March 1988 and November 1992 and who had a follow-up period longer than 3 months. All patients had a second-generation test (ELISA + RIBA) for HCV antibodies (HCV Ab) before and monthly after OLT; all had a polymerase chain reaction (PCR) test for detection of viral RNA after the operation. Whenever biochemical abnormalities (hypertransaminasemia 2 times the normal range) were seen, a percutaneous liver biopsy was performed. Forty-two HCV Ab+ patients before OLT remained positive after OLT. In this group the PCR test was positive in 32 cases (78.5%). In 13/42 (30.9%) cases (all PCR+) with hypertransaminasemia histological examination showed signs of viral C hepatitis (score of Knodell minimum 3, maximum 12, median 5.5). Of 53 HCV Ab patients before OLT, only 1 became HCV Ab+ and PCR+ 15 months after OLT. In the remaining 52 patients 15 were PCR+. Twenty of 53 patients (37.7%) had a liver biopsy because of hypertransaminasemia: in no case did histology show any signs of hepatitis C. In conclusion, viral C recurs often after OLT for post-hepatitic C cirrhosis. The histological graft lesions are in most cases moderate. We did not observe any deaths related to viral C infection in grafted patients. According to our results post-hepatic C cirrhosis remains a good indication for OLT.

Adult↗
PubMed1994

[Diagnostic laparoscopy and laparoscopic surgery--their development and outlook].

Laparoscopy was introduced in the beginning of the 20 century. It is developed as a diagnostic procedure, often combined with biopsy. In the 80 ies the laparoscopy came in surgery, first in appendectomy, later in cholecystectomy, where it achieved exclusive appliance and became an alternative method of conventional surgery. In the beginning of 90-ies the laparoscopic surgery treats more and more of diseases of abdominal surgery.

Abdomen↗
PubMed1994

Laparoscopic posterior vagotomy and anterior seromyotomy.

Laparoscopic truncal vagotomy with anterior seromyotomy, as described by Taylor, is our operation of choice in open surgery for elective treatment of chronic duodenal ulcer because it is a rapid, reliable and efficacious procedure. This procedure also does not have the variability of highly selective vagotomy in relation to the surgeon who is performing the operation. The technique is standardised and the results on 90 patients showed minimal morbidity and no mortality with a recurrence rate of 4.2% after a follow-up of 2-41 months. These results are very similar to those obtained in open surgery and compare favorably with the recurrence results after medical treatment. The procedure is therefore effective and safe and should be included in the armamentarium of treatment of chronic duodenal ulcer resistant to a thorough medical treatment.

Adult↗
PubMed1993

[Biliary complications after a liver transplant].

Biliary tract complications are still an important source of morbidity and mortality after liver transplantation. Between March 1988 and September 1991 we performed 111 liver transplants in 109 patients (84 men and 25 women, mean age 44.5 +/- 1.1 year). Biliary tract reconstruction was via a choledocho-choledochostomy (n = 107) or via a Roux limb choledochojejunostomy (n = 4). Ten biliary complications (11.9%) occurred (6 biliary leakage, 3 biliary strictures, 1 biliary cast syndrome). Five patients (5.9%) necessitated operative repair (Roux limb choledochojejunostomy). No death was related to biliary tract complication.

Adult↗
PubMed1993

Simple column liquid chromatographic assay for serum neopterin.

A simple high-performance liquid chromatographic assay for serum neopterin with highly sensitive fluorimetric detection (limit 1 nM) is proposed. Comparison with results obtained by radioimmunoassay revealed a good correlation between the two techniques. The potential use of this method for the follow-up of liver transplant patients is discussed.

Adult↗
PubMed1993

[Dissection of the Calot's triangle by the celioscopic approach].

Laparoscopy seems to increase the frequency of post-cholecystectomy biliary complications. Irrespective of the instruments and techniques utilized, dissection of Calot's triangle must be performed in compliance with the classical rules of bile duct surgery. These rules are: always keep in contact with the gallbladder; completely dissect the Calot's triangle area which must not contain more than one biliary tract element; never dissect the cystic duct beyond the right border of the hepatic choledochus; never section an element that is not identified with certainty; systematically perform a peroperative transcystic cholangiography, in particular to detect the anatomical variants of the extra-hepatic biliary ducts.

Cholecystectomy, Laparoscopic↗