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Biomedical subjects

J P Joly

Publications and source records attributed to J P Joly.

At least 19 recordsLinked to original sources

A simple technique to concentrate the protozoan Mikrocytos mackini, causative agent of Denman Island Disease in oysters.

This report describes a simple filtration technique to isolate the parasite Mikrocytos mackini from oyster tissue. The technique is based on successive filtration through filter papers and polycarbonate membrane filters of decreasing mesh using a low vacuum (<8 cm Hg). This technique allows for the recovery of about 1 x 10(8) parasites (microcells) from about 2 g of heavily infected oyster tissue. About 99% of the particulate material in the final preparation consisted of intact M. mackini.

Animals↗

Prevalence of alcohol problems among elderly patients in a university hospital.

AIMS: To assess the prevalence of alcohol abuse and the prevalence of alcohol-related discharge diagnosis in an elderly general hospital population. DESIGN: On a randomly selected day, all patients aged 65 years and over admitted to a university hospital were screened. SETTING: University Hospital of Amiens, France. PARTICIPANTS: All patients aged 65 years and over were approached and requested to take part in the study. They were interviewed using the CAGE questionnaire and with a structured questionnaire regarding life-style, and asked about their usual daily alcohol consumption. The medical history of each patient was taken. In total, 612 patients fulfilled the age criteria, but 205 patients (33.6%) had to be excluded owing to predefined exclusion criteria (e.g. dementia, aphasia, terminal illness ...) and 37 patients (6%) refused to participate. FINDINGS: The data were derived from 370 patients. The median age was 79 years; 54% reported no alcohol consumption; 9% of patients scored positive on the CAGE questionnaire. The prevalence of patients with a CAGE questionnaire positive was significantly higher among male patients (17%) than female patients (2.5%). The prevalence of patients with alcohol-related discharge diagnosis was 7%. The frequency of higher socio-economic status or divorced status increased significantly with alcohol consumption. CONCLUSIONS: There may be a substantial prevalence of alcohol problems in elderly hospital patients. Research is needed to examine how generalized this problem is.

Aged↗

Alcohol use disorders in French university hospital patients.

The adult patients of the somatic departments of Amiens University Hospital were screened on a randomly selected day by interviewers who examined them using a structured questionnaire regarding lifestyle, with the CAGE questionnaire, and their daily alcohol consumption. The medical histories of all patients were collected. A patient was considered having an alcohol problem if one or more of the following criteria was fulfilled: (1) a CAGE questionnaire score of 2 or more positive answers; (2) an alcohol-related diagnosis. In total, 869 patients fulfilled the entry criteria (377 patients were excluded owing to predefined exclusion criteria). A hundred and sixty-seven patients (19.2%) fulfilled 1 or 2 of the criteria for an alcohol problem. Eighty-eight patients (10.1%) had an alcohol-related discharge diagnosis. The prevalence of patients with a positive CAGE score was 13.5% and was significantly higher among male patients (22.7%) than among female patients (5.5%). The frequency of a higher socioeconomic status or the status of 'living alone' increased significantly with alcohol consumption.

Adolescent↗

Hepatic nodules as single organ involvement in an adult with Langerhans cell granulomatosis. A case report.

Liver involvement manifesting as hepatomegaly in Langerhans cell granulomatosis (LCG) is well known, but the definitive diagnosis is generally possible because other organs are involved. We report a 41-year-old white man who presented with cholestasis and liver nodules as an isolated hepatic LCG. The diagnosis of LCG was suspected based on routine histopathologic examination; the diagnosis became definitive 4 years later when Birbeck granules were found in the liver, an uncommon occurrence in this organ. This is an unusual presentation of a benign form of this disease and one of the first that reported Birbeck granules in the liver.

Adult↗

[Percutaneous cholecystostomy. A study of 30 patients].

OBJECTIVE AND METHODS: The treatment of acute cholecystitis or angiocholitis is often difficult in elderly or very ill patients. The aim of this retrospective study was to assess the efficacy and the results of ultrasound guided percutaneous cholecystostomy in patients with acute cholecystitis or biliary tract obstruction and anesthetic or surgical contraindications. RESULTS: Thirty patients (25-93 years, 16 men and 14 women) were included in this study. Ultrasound guided percutaneous cholecystostomy was successful on the septic syndrome in 27 patients; endoscopic sphincterotomy was performed in 6 patients after clinical improvement. A failure of the procedure on sepsis was observed in 3 patients: cholecystectomy was performed after cardiac improvement in one patient, and 2 patients died. Two other patients died of extradigestive diseases. No serious complication related to cholecystostomy was observed. CONCLUSION: Ultrasound guided percutaneous cholecystostomy is a safe and simple procedure. It can be done at bedside and has low morbidity and mortality. It can be considered as a definitive treatment, or a temporary one with secondary surgical or endoscopic management.

Adult↗

Cirrhosis: a new, but expected cause of biliary sludge.

BACKGROUND/AIMS: Biliary sludge is increasingly recognized as a natural stage in gallstone formation. Logically, cirrhosis, a well-documented cause of black pigment cholelithiasis, should be another condition predisposing to the development of sludge. The aim of this study was to assess the prevalence of biliary sludge in an unselected population and to test the hypothesis that cirrhosis could be one of the causes of sludge. METHODS: We reviewed the clinical findings and ultrasonograms of 2138 patients, hospitalized or not, consecutively seen in our department between January 1993 and December 1994. Sonograms showing biliary sludge mixed with stones were excluded. Three hundred and eighty-eight of the 2138 were cirrhotic patients. RESULTS: The overall prevalence of biliary sludge was 4%. Sludge was found in 44 of 388 (11%) of the cirrhotic patients (alcoholism, n = 39; chronic viral B hepatitis, n = 3; hemochromatosis, n = 1; and cryptogenic, n = 1), compared with 42 of 1750 (2%) noncirrhotic patients (p < 0.000001). Thirteen cirrhotic patients received intravenous alimentation for 2 to 17 days, 8 were given somatostatin for variceal bleeding, and 7 have previously had 1 to 5 sessions of endoscopic sclerotherapy of esophageal varices with polidocanol. CONCLUSIONS: This study convincingly demonstrates that cirrhosis must be added to the growing list of conditions associated with biliary sludge.

Adult↗

[Ambulatory ultrasound-guided puncture in abdominal tumoral pathology. Study of 131 cases].

OBJECTIVES AND METHODS: Outpatient ultrasound guided liver biopsy is usually reserved for diffuse pathologies. The aim of this study was to assess the feasibility and results of 131 ultrasound guided biopsies of 128 abdominal lesions in 104 patients (69 men and 35 women, mean age: 59). Twenty four cysts were punctured (18 pancreatic cysts, 4 liver cysts and 2 unspecified abdominal cysts) and 104 solid tumors were biopsied (80 liver tumors, 9 pancreatic tumors, 5 portal vein obstructions, 4 unspecified abdominal tumors, 3 stomach tumors and 3 lymphadenopathies). RESULTS: The feasability of outpatient ultrasound guided biopsy was 100%. The etiology of 22 cysts (91.6%) and the histology of 100 solid tumors (96.2%) were determined. No side effects were observed, and all patients left the hospital 6 hours after this procedure. No later hospitalisations were necessary. CONCLUSION: This study suggests that outpatient ultrasound guided needle aspiration or biopsy of liver tumors or other abdominal tumors can be performed. Thus, this procedure could be less expensive and more acceptable, while preserving reliability and safety.

Abdominal Neoplasms↗

Fibrotic stricture of the extrapancreatic biliary tract: a new complication of acute pancreatitis. Two cases.

Two cases of fibrotic stricture of the extrapancreatic common bile duct were observed 3 and 5.5 months after severe acute alcoholic pancreatitis. The diagnosis was made by endoscopic retrograde cholangiography in both cases. Although colonic or ureteric stenosis have been reported after acute pancreatitis, this is the first report of extrapancreatic biliary stricture occurring after acute pancreatitis. The strictures could have arisen by either an enzymatic or ischemic mechanism. Outcome was favorable after surgical hepaticojejunostomy.

Acute Disease↗

[Endoscopic treatment of a pancreatic-pleural fistula. Apropos of a case].

Pancreaticopleural fistula is a rare complication of pancreatic diseases. It results from communication between a pancreatic duct and the pleural space, either directly, or through a pseudocyst. The treatment is medical or surgical. We report a case of pancreaticopleural fistula occurring in a man suffering from chronic pancreatitis, and treated by endoscopy.

Adult↗

Occult hepatocellular carcinoma in cirrhosis: value of ultrasound-guided biopsy of portal vein system thrombus.

We report two cases of occult hepatocellular carcinoma associated with alcoholic cirrhosis, in which the diagnosis of malignancy was respectively established by ultrasound-guided biopsy of umbilical vein and portal vein branch thrombus. When measurement of serum alpha-foetoprotein, and liver ultrasonography and/or computed tomography failed to clearly demonstrate hepatocellular carcinoma, the presence of a thrombosis of the portal vein system is highly suggestive of malignancy, which may be easily confirmed by venous biopsy.

Aged↗

[Prognostic factors of hepatocellular carcinoma. Multifactorial analysis of 84 cases].

To identify prognostic factors taking in account recent advances in diagnosis and treatment, 24 clinical, biological, and morphological factors were evaluated by means of uni- and multivariate analysis in 84 patients with hepatocellular carcinoma diagnosed between 1984 and 1991. Okuda's grading (P < 0.01), creatininemia (P < 0.01), and treatment (P < 0.05) were independent prognostic factors. Des-gamma-carboxyprothrombin reached a significant level (P < 0.05) in a subgroup of 32 recent patients but its prognostic value needs to be confirmed. Further prospective randomized trials comparing surgical and non-surgical treatment should take these factors into account.

Adult↗

Endoscopic diagnosis and treatment of Mirizzi's syndrome.

Mirizzi's syndrome is the name given to common bile duct obstruction secondary to a stone in the cystic duct. The cause of the biliary obstruction is often difficult to establish before operation. We report two cases of Mirizzi's syndrome, diagnosed endoscopically and treated without surgery. One of the patients was treated by drainage of both the common bile duct and the gallbladder associated with monooctanoin dissolution of the gallstone. The other was treated by common bile duct stenting.

Aged↗