[Indications and results of the endoscopic treatment of hemorrhaging ulcers].
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Duodenal Ulcer↗
Biomedical subjects
J Sahel
Publications and source records attributed to J Sahel.
[Medical and endoscopic treatment of chronic pancreatitis].
Analgesics and pancreatic extracts are required for the management of pancreatic pain. The use of pancreatic enzymes supplements is necessary for the management of pancreatic insufficiency. Patients with diabetes should be treated with insulin since endogenous insulin secretion is decreased. Drainage procedures of the pancreatic ducts, drainage of pancreatic cysts and biliary prosthesis are different ways of endoscopic management for chronic pancreatitis and its related complications. Endoscopic drainage procedures of the pancreatic duct include pancreatic sphincterotomy, extraction of pancreatic stones by means of balloons or baskets or extra corporeal shock wave lithotripsy, pancreatic duct endoprosthesis. Clinical and anatomical results are good or fair in about two thirds of the cases but there are not yet controlled studies. Endoscopic management of pancreatic cysts use transmural drainage of cysts in contact with the stomach or duodenal wall or transpapillary drainage in cysts communicating with the pancreatic ductal system. The results and complications of the endoscopic treatment of pancreatic cysts are comparable to those of surgical series. Biliary stenting is an alternative to surgical diversion. Endoscopic management of chronic pancreatitis requires the development of new techniques which should be evaluated in further controlled studies.
Calculi↗
Endoscopic ultrasonographic diagnosis of pancreatic cancer complicating chronic pancreatitis.
BACKGROUND AND STUDY AIMS: Pancreatic cancer is a rare complication of chronic pancreatitis (CP), and its diagnosis remains difficult. The present study attempted to evaluate the ability of endoscopic ultrasonography (EUS) to diagnose pancreatic masses associated with CP and provide evidence of malignancy in patients with a pancreatic mass on EUS. PATIENTS AND METHODS: Between 1991 and 1994, EUS examinations yielded a diagnosis of CP in 85 patients at our institution. Forty patients had early CP, 18 had pancreatic pseudocysts complicating CP, and 27 had advanced chronic pancreatitis - five of whom were considered as presenting pancreatic cancer associated with CP. RESULTS: The five patients studied had jaundice, weight loss, and calcifications visible on plain abdominal films. Three of them had histological confirmation of pancreatic carcinoma. The pancreatic carcinomas were hypoechoic masses of 20-35 mm, with an irregular, rounded shape. Calcifications were limited to the periphery of the hypoechoic masses. Two patients had negative EUS-guided cytological punctures, and are still alive two years later. They were considered as false-positive cases. EUS showed a hypoechoic mass with peripheral calcifications in one of these false-positive patients, with a large central calcification in the other case. The overall sensitivity of EUS for the diagnosis of pancreatic carcinoma was 100%, but the positive predictive value was 60%. CONCLUSION: EUS is highly sensitive in detecting abnormal masses in cases of CP, but the positive predictive value of the diagnosis of pancreatic cancer seems to be weak.
Aged↗
Human Usher 1B/mouse shaker-1: the retinal phenotype discrepancy explained by the presence/absence of myosin VIIA in the photoreceptor cells.
Usher syndrome type 1 (USH1) associates severe congenital deafness, vestibular dysfunction and progressive retinitis pigmentosa leading to blindness. The gene encoding myosin VIIA is responsible for USH1B. Mutations in the murine orthologous gene lead to the shaker-1 phenotype, which manifests cochlear and vestibular dysfunction, without any retinal defect. To address this phenotypic discrepancy, the expression of myosin VIIA in retinal cells was analyzed in human and mouse during embryonic development and adult life. In the human embryo, myosin VIIA was present first in the pigment epithelium cells, and later in these cells as well as in the photoreceptor cells. In the adult human retina, myosin VIIA was present in both cell types. In contrast, in mouse, only pigment epithelium cells expressed the protein throughout development and adult life. Myosin VIIA was also found to be absent in the photoreceptor cells of other rodents (rat and guinea-pig), whereas these cells expressed the protein in amphibians, avians and primates. These observations suggest that retinitis pigmentosa of USH1B results from a primary rod and cone defect. The USH1B/shaker-1 paradigm illustrates a species-specific cell pattern of gene expression as a possible cause for the discrepancy between phenotypes involving defective orthologous genes in man and mouse. Interestingly, in the photoreceptor cells, myosin VIIA is mainly localized in the inner and base of outer segments as well as in the synaptic ending region where it is co-localized with the synaptic vesicles. Therefore, we suggest that myosin VIIA might play a role in the trafficking of ribbon-synaptic vesicle complexes and the renewal processes of the outer photoreceptor disks.
Adult↗
Two forms of hereditary chronic pancreatitis.
We report 11 families of hereditary pancreatitis characterized by the presence of calculi in pancreatic ducts. These were classified as (1) calcic lithiasis (one family with five cases), in which the calculi are composed of >95% calcium salts; and (2) protein lithiasis in 10 families, in which the calculi are composed of degraded amorphous residues of lithostathine, the pancreatic secretory protein that inhibits calcium salt crystallization. In both forms, transmission appears to be dominant. The average age at clinical onset of symptoms is 15 years. The clinical progression seems to be less severe than in alcoholic chronic pancreatitis (alcoholic calcic lithiasis). This report shows for the first time that hereditary chronic pancreatitis is a group of at least two diseases having a similar clinical picture and pathological features but different chemical compositions of calculi. This leads us to propose a revised Marseille-Rome classification.
Adult↗
Simplified ganglioside composition of photoreceptors compared to other retinal neurons.
PURPOSE: The quantitative and qualitative ganglioside composition of retinal photoreceptor cells is unknown. The aim of this study was to analyze the lipid, especially ganglioside, make-up of photoreceptors compared to other retinal cells. METHODS: Retinas from adult normal rats were mechanically separated into outer (photoreceptors) and inner (other retinal neurons and glia) halves be planar vibratome sectioning. Total lipids were extracted, and each fraction (neural, phospholipids, and glycosphingolipids) was eluted sequentially by column chromatography and quantitated through high-performance thin layer chromatogram analysis. Similar analyses were performed on entire retinas from adult normal rats, adult dystrophic rats lacking photoreceptors (RCS-rdy-p+ strain), and isolated photoreceptor outer segments. RESULTS: Whereas phospholipids were distributed equally between the two halves, inner retina contained significantly more cholesterol (68% total) and gangliosides (74% total) than outer retina on a unit protein basis. The distribution on a percent molar basis of specific gangliosides also was significantly different between the two halves: Outer retina was dominated by GD3 (45% total ganglioside) and contained only trace amounts (<4%) of complex species (GT1b and GQ1b); inner retina was more typical of mature brain tissue exhibiting substantial amounts (approximately 25%) of more complex species. These data were supported by lipid compositional analyses of mutant photoreceptor-less retina. However, isolated outer segments resembled whole retina in containing higher levels of complex gangliosides. CONCLUSIONS: These data indicate that, compared to other central nervous system-derived neurons, photoreceptor cell body membranes exhibit a highly unusual simplified ganglioside composition. Such an unusual neuronal lipid composition may reflect structural adaptations to their specialized function.
Animals↗
[Detection, monitoring and treatment of diabetic retinopathy. Recommendations of ALFEDIAM. Committee of above-mentioned experts and validated by the board of directors and scientific board of ALFEDIAM].
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Cataract Extraction↗
Immunohistochemical detection of hepatitis C virus related C100-3 and core antigens in formalin-fixed liver tissue.
HCV C100-3 non-structural and core proteins have been detected by immunohistochemical methods on paraffin-embedded tissue sections using monoclonal antibodies in 22 cases of chronic hepatitis C. C100-3 protein was detected in cytoplasm and nuclei of hepatocytes whereas core protein was only detected in nuclei. The specificity of the nuclear localization of HCV antigens was discussed in relation to cross-reactivity of the anti core antibody with host-derived GOR antigen.
Antigens, Viral↗
Survival and regeneration of adult human and other mammalian photoreceptors in culture.
PURPOSE: Fully mature neurons of central nervous system origin generally are considered unable to survive for extended periods of time in simple culture conditions. The authors report that adult and aged human, porcine, and rodent retinal neurons, including rod and cone photoreceptors, constitute an exception to this idea. METHODS: Cells were dissociated from human postmortem retinas, adult mammalian retinas, and selected brain regions and were seeded into tissue culture plates and left to develop as monolayer cultures for up to 2 months. A battery of antibody markers was used to identify the nature and morphology of the cells in vitro. RESULTS: Photoreceptor cell survival of rods and cones was observed routinely when the delay between the time of death until culture preparation was 50 hours or less, compatible with current eye bank practice. Two-week-old cultures were formed of rod photoreceptors, representing approximately 50% of neuronal cell types; cone photoreceptors, representing 5% to 30% of neuronal cell types; other retinal neurons (especially amacrine cells approximately 20%); and retinal glial cells, present in variable numbers. Glial cells were essential for long-term photoreceptor survival and neurite outgrowth. Adult mammalian brain neurons isolated under the same conditions did not survive. CONCLUSIONS: Fully adult human and other mammalian retinal neurons, including photoreceptors, exhibit remarkable plasticity in vitro, and such monolayer models may have applications in physiological, pharmacologic, and toxicologic studies of human and other mammalian retina.
Aged↗
Association of intermediate uveitis with HLA-A28: definition of a new systemic syndrome?
BACKGROUND: Endogenous posterior uveitis (PU) can be associated with systemic diseases, and certain forms have strong association with HLA antigens. Much less is known regarding intermediate uveitis (IU). The purpose of this study was to determine whether IU is associated with the HLA system and whether it can be associated with systemic symptoms. METHODS: In 179 consecutive patients consulting for uveitis, a detailed history was obtained and a physical examination performed. HLA typing for 71 HLA-A, B, DR and DQ antigens, laboratory tests, and radiography of the chest, sinuses, and sacroiliac joints were systematically performed. RESULTS: Thirty-two patients (18%) had IU; 51 (28.5%) had PU and constituted our internal control group. Nine of the patients with IU (28%) had the HLA-A28 antigen, compared with 8.1% of a healthy control population and 8.6% of the patients with PU (P < 0.001). An associated disease was found in four patients with IU (12.5%) (none was HLA-A28) and in 45% of the patients with PU (P < 0.01). Some 67% of HLA-A28 patients with IU had arthralgias affecting the knee(s), compared with 17% of non-HLA-A28 patients and 18% of patients with PU (P < 0.05 and P < 0.01 respectively); 55% had gonalgias and hypocomplementemia compared with 9% and 2% respectively (P < 0.01 and P < 0.001). CONCLUSIONS: IU is significantly associated with HLA-A28; patients having this antigen may represent a subset of the disease characterized by an increased prevalence of arthralgias and hypocomplementemia.
Adolescent↗
[Kaposi disease, limited to the skin, in ulcerated hemorrhagic rectocolitis].
We report the first case of limited cutaneous Kaposi's sarcoma during ulcerative colitis, in a HIV-negative 68 year-old man without any risk factors for this tumor. In our case, the steroid-therapy necessitated by the colitis is the most important aetiological factor of the sarcoma and its withdrawal leads to a complete remission of the tumor. The link between steroid-therapy and Kaposi's sarcoma is well known. A link between ulcerative colitis and Kaposi's sarcoma can be discussed but not proven. The possible occurrence of this cutaneous tumor during ulcerative colitis is of interest.
Aged↗
Ultrasound guided percutaneous ethanol treatment of hepatic neoplasms: a therapeutic alternative in the nineties.
This paper describes ultrasound guided percutaneous ethanol treatment of hepatocellular carcinoma (HCC), which was introduced in 1985 as an alternative to surgical resection. Previous studies have reported the applicability of this technique to tumors less than 50 mm in diameter. In our own work, we have successfully treated tumors as large as 70 mm in diameter with very large volumes of absolute ethanol.
Carcinoma, Hepatocellular↗
Endoscopic transpapillary drainage of pancreatic pseudocysts.
BACKGROUND: Endoscopic therapy of pancreatic pseudocysts has been reported mainly in small series. METHODS: The results of endoscopic transpapillary cyst drainage (ETCD) were evaluated prospectively in 30 patients with pancreatic pseudocysts. RESULTS: There were 24 men and 6 women with an average age of 45 years (SD 16). Twenty-eight had chronic pancreatitis (25 with alcoholic pancreatitis). Transpapillary cystopancreatic stents, with the tip into the cyst cavity, were inserted in 12 patients. Pancreatic stents with the tip as close as possible from the cyst cavity were inserted in the remaining 18 patients. Ten patients underwent an additional endoscopic cystenterostomy. The average duration of stenting was 4.4 months (range 15 days to 12 months). Patients were followed up for 15 months (range 2 to 60 months). All pseudocysts communicated with the pancreatic ductal system. The size of the pseudocysts ranged from 15 to 120 mm (average 50 mm). Pseudocysts were mainly located in the head of the pancreas (17 cases). Four minor complications occurred. There were no deaths. Twenty-six patients had pseudocyst resolution by ETCD, but 7 ultimately required surgery, 3 for early recurrence and 4 for failure of initial therapy. CONCLUSION: ETCD appears to be a safe and efficient modality for the drainage of pancreatic pseudocysts communicating with the pancreatic ductal system.
Acute Disease↗
An association between villous adenomas and mucinous ductal ectasia of the pancreas.
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Adenocarcinoma, Mucinous↗
Clinical course and morphological features of chronic calcifying pancreatitis associated with pancreas divisum.
OBJECTIVES: To describe the clinical and radiological patterns of chronic calcifying pancreatitis (CCP) associated with pancreas divisum. DESIGN: Case-control study. METHODS: Pancreas divisum was diagnosed in 20 out of 411 patients presenting with CCP between 1985 and 1994 (group I). They were matched for age and sex with 20 patients presenting with CCP but without pancreas divisum (group II). The cause of CCP was presumed to be mainly chronic alcohol use, as 18 patients in each group had heavy alcohol consumption. RESULTS: The age at onset of the disease was comparable in the two groups (mean 40.8 compared with 42.4 years, NS), and consumption of alcohol and tobacco did not differ. Pancreatic calcified calculi were seen on plain films of the abdomen in eight patients from group I and in 14 patients from group II (P = 0.05). Loss of weight (> 5 kg), diabetes, portal hypertension and the rate of complications of chronic pancreatitis were not significantly different in the two groups. The frequency of attacks of acute pancreatitis was similar (mean 0.9 compared with 1.2 per year, range 0.2-6.0 per year, NS). The occurrence of pseudocysts did not differ (11 compared with 15, NS). Pancreatograms were categorized using the Cambridge classification. No differences could be demonstrated between the two groups (chi 2, P = 0.15). In group I, pancreatographic abnormalities were located only in the ventral segment of the pancreas in three patients, only in the dorsal segment of the pancreas in nine patients and in the whole pancreas in six patients. In two patients, the ventral duct could not be demonstrated. CONCLUSION: We conclude that pancreas divisum does not modify the natural course of CCP. In about one-half of cases, pancreatographic abnormalities may be segmental.
Adult↗
Quantification of human lithostathine by high performance liquid chromatography.
Pancreatic stones of patients with chronic calcifying pancreatitis (CCP) are mostly made up of CaCO3 crystals. Formation and growth of such crystals is inhibited in vitro by lithostathine, a protein present in normal pancreatic juice. Decreased lithostathine activity was therefore suspected in patients with CCP, but comparison by immunoassay of lithostathine concentrations in the pancreatic juices of patients and controls led to conflicting results. This study shows that these discrepancies might have been caused in part by a remarkably high susceptibility of the protein to trypsin like cleavage, resulting in important structural changes and concomitant modifications of the epitopes. A novel lithostathine assay in juice was developed, based on separation of secretory proteins by high performance liquid chromatography. The chromatographic separation of lithostathine was based on hydrophobic interactions at pH 5.0 using a Phenyl-TSK column. This study showed with this assay that lithostathine concentrations (microgram/mg of total protein) were similar in CCP patients with alcoholic aetiology (mean (SD) 6.3 (2.7)) and other aetiologies (7.2 (3.7)), but one third of those estimated in patients without pancreatic disease (16.7 (4.3)). Similar concentrations were found, however, in chronic alcoholic patients without CCP (6.6 (3.3)) and in patients with CCP. It was concluded that decreased lithostathine concentration is associated with CCP, although such a decrease is not sufficient by itself for the disease to occur.
Alcoholism↗
Is biliary lithiasis associated with pancreatographic changes?
The aetiological role of biliary lithiasis for chronic pancreatitis remains controversial. Previous studies based on pancreatographic studies reported changes in the pancreatic duct system caused by biliary lithiasis. This study analysed retrospectively the endoscopic retrograde cholangiopancreatography of 165 patients presenting with biliary lithiasis and of 53 controls. Among the 165 patients, 113 had choledochal stones (53 with gall bladder stones, 50 had had a cholecystectomy, 10 with a normal gall bladder), 35 had gall bladder stones without choledochal stones, 17 had cholecystectomy for gall bladder stones. Pancreatograms were analysed by measuring the diameter of the pancreatic duct in the head, the body, and the tail of the pancreas, and evaluating the regularity of the main pancreatic duct and the presence of stenosis, the regularity or the dilatation of secondary ducts, and the presence of cysts. In addition, we established a score, based on the above parameters, by which pancreatograms were classified as normal or with mild, intermediate, moderate or severe abnormalities. A multivariate analysis (stepwise multiple discriminant analysis) was performed for age, sex, presence of gall stones, presence of choledochal stones. Patients were comparable with controls for sex, alcohol consumption but were younger (55 v 68 years, p < 0.01). In patients and in controls, the frequency of pancreatographic abnormalities increased significantly with age. The pancreatographic features of patients and controls were not significantly different. In the multivariate analysis, age was the only factor with significant predicting value for pancreatographic abnormalities. In conclusion, biliary lithiasis in itself is not an aetiological factor for chronic pancreatitis, older age being responsible for the abnormalities seen by pancreatography of patients with biliary lithiasis.
Bile Duct Diseases↗
Systemic sarcoidosis initially presenting as an orbital tumour.
A 73 year old woman presented with redness, itching and painless proptosis of the left eye. Clinical examination and computed tomographic (CT) scan of the orbit revealed a postero-ocular mass, the biopsy of which showed a noncaseating, giant cellular, epithelioid granuloma compatible with sarcoidosis. The patient had no respiratory complaints, but the thoracic CT scan showed multiple bilateral hilar and mediastinal adenopathies. Gallium scan showed increased uptake in both hilar regions, in the left orbit and in the right parotid gland. Multiple bronchial biopsies revealed sarcoid granulomas, with a bronchoalveolar lavage (BAL) cytological pattern of active sarcoidosis. The evolution was favourable with prednisolone given at a dose of 0.5 mg.kg-1 daily. It is suggested that in an unusual presentation of sarcoidosis, a thorough search should be made for localization at other sites, lungs in particular, even in the absence of respiratory complaints.
Aged↗