Biomedical subjects
Publications and source records attributed to J Visset.
Gallbladder percutaneous drainage under ultrasound guidance could offer an interesting option compared to surgery in multi-systemic disease patients with acute cholecystitis and who are considered as high-risk patients towards anesthesia and surgery. The authors describe this technics which is an easy, quick and eventually repetitive procedure with no major complications.
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The authors report the case of a 51-year-old man with gastric leiomyoblastoma, presenting with a history of gastrointestinal bleeding and hemoperitoneum. CAT scan showed a mass measuring 10 x 10 cm arising from the stomach. At laparotomy the mass extended into the gastrosplenic omentum. A splenopancreatectomy was performed and the mass was excised for biopsy. The cytologic findings suggested a mesenchymal tumor; histology demonstrated the diagnosis of leiomyoblastoma. The postoperative course was uneventful. In the literature there is no evidence that intraperitoneal bledding from these tumors worsens survival. The cytopathologic features of leiomyoblastoma are discussed.
Liver Hydatid cysts located close to the inferior vena cava and the sus-hepatic veins are known for their risk of rupture inside these veins. The authors report the case of a patient who died from massive pulmonary embolism during the surgical treatment (hepatectomy) of liver hydatid cysts. Diagnosis and treatment of these fistula are reviewed.
Surgical approach of benign nodules and goiters in euthyroid patients is not yet well definite concerning the latent of the resection: has it to be large (for avoiding recurrence) of thrifty (in the aim of decreasing the necessity of postoperative thyroid replacement therapy)? We reviewed the results of 338 surgical thyroidectomies in patients followed at least 7 years. 87.36% of them had diffuse pathological abnormalities. Recurrence level was 1.68% in this group, occurring in an average delay of 10 years after the first thyroidectomy. Another study group concerned 47 patients operated for a recurrence in an average of 13.9 years after the first thyroidectomy (mean age at the first thyroidectomy: 35 years). Post operative sequellae after one thyroidectomy or after a second for recurrence seemed not statistically different. Recurrence rate is not important, but it is probably underevaluated by the frequent absence of long-term follow-up. Total thyroidectomy avoids it, and its sequellae are comparable with those observed after reoperation for recurrence. The surgical choice is between the acceptation of a possible recurrence and the necessity of an indefinite thyroid replacement therapy.
The possibility of an immunological follow-up of the pancreas through the renal transplant after simultaneous pancreaticorenal transplantation (S.P.R.T.) is controversial. Fifty patients have received a neopren-injected extraperitoneal segmental pancreatic transplant and a contralateral renal transplant, after immunological preparation with blood transfusions, without tissue matching but with a negative anti-T lymphocyte cross-match. Immunosuppression consisted in a three- or four-drug therapy during the first 10 days, then a long-term two-drug therapy (ciclosporine and azathioprine). Sixteen rejection episodes were noted in 16 patients during the first 3 postoperative months. No concomitant alteration of the pancreatic function occurred (no pancreatic histology). No isolated pancreatic rejection has been noted so far. One patients presented with 2 episodes of simultaneous rejection 15 and 26 months after transplantation. The actuarial survival rate at 2 years of the patients, kidneys and pancreata respectively is 96%, 92% and 80%. The absence of long-term alteration of the pancreatic function probably proves the absence of undetected pancreatic rejection. In our experience, the follow-up of the renal function allows screening and treating rejection episodes before a possible functional alteration of the pancreatic transplant occurs. In our opinion, extraperitoneal segmental pancreatic transplantation, a simple procedure with satisfactory metabolic results in the long term, is a good technique for S.P.R.T.
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The study was undertaken to define the potential use of indium 111 carcinoembryonic antigen-specific antibody labelled [CEA F(ab')2] for the radioimmuno-detection of colorectal carcinoma using an intraoperative hand-held gamma probe. The use of a linear radioactive source allowed optimization of physical characteristics. The best results regarding sensitivity and resolution were obtained using a 5-mm thick tungsten alloy collimator. A simulation study with a liver phantom (22 MBq or 0.6 mCi) was performed to determine the effect of side scatter as opposed to direct background and showed that it is possible to detect small radioactive targets (3.7 KBq or 0.1 mu Ci) 4 cm from the phantom. A clinical study performed with ten patients showed that tumours with good uptake of CEA-specific antibody could be detected with sufficient contrast in two patients when the probe was used. Results of a biodistribution study performed after tumour fragment or normal tissue countings in a well counter showed high tumour uptake (above 8 x 10(-3) injected dose/g) and tumour-to-normal tissue ratios (between 2.5 and 20) in five patients. Results with the probe showed markedly lower ratios. There was no correlation between absolute tumour uptake and the count rates of tumour measured intraoperatively. This can be attributed to the degradation of depth resolution resulting from the high energy photopeak of gamma-emitting 111In.
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We studied five cases of poorly differentiated follicular or papillary thyroid carcinomas. Immunohistochemical study revealed numerous ACE positive cells, also positive for calcitonin, ACTH, somatostatin or several of these peptides. These tumors containing both vesicular component and parafollicular cells are endocrine tumors of "mixed" or "intermediate" type. The diagnosis must be confirmed by immunohistochemistry but can be suggested by histological findings: abundant fibrous stroma, trabeculovesicular pattern, and swelled moderately acidophilic cells neighbouring vesicular cells. These facts argue in favor of a common-embryological origin of vesicular and parafollicular cells from ultimobranchial undifferentiated cells. Nevertheless such tumors must take place in thyroid neoplasia's classifications and an appropriate terminology remains to be precised.
A case of hypoglycaemia consecutive to excision of a bilateral phaeochromocytoma in a 33-year old patient with Sipple's syndrome is reported. The severity of the hypoglycaemia (1.3 mmol/l) accounted for the brain lesions which ultimately resulted in the patient's death. Eight cases of hypoglycaemia occurring in similar circumstances have been published. The condition is due to the massive release of insulin during the hours that follow removal of the tumour. This results in the persistence of the peri-operative hyperglycaemic stimulation and in the suppression of the previous inhibition of insulin secretion due to alpha-adrenergic stimulation of catecholamines in the beta-cells of Langerhans' islets.
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A 51-year-old man had epidermoid carcinoma in the middle third of the esophagus. The esophagus was resected. On histologic examination there was a granular cell tumor in the lower third of the esophagus. The patient died 4 months after surgery from pulmonary failure. Granular cell tumors are generally benign. There have been 86 cases involving the esophagus discussed in the literature; 7 cases were associated with bronchial [3], esophageal [2], gastric [1] or otolaryngeal [1] carcinoma and 1 with a lymphoma. Our case emphasizes the need to evaluate the entire esophagus when a lesion is identified. The occurrence of granular cell tumor of the esophagus justifies prolonged surveillance in order not to neglect an associated tumor.
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The aim of this retrospective study was to correlate the results of hormonal immunocytochemistry of 46 endocrine tumors to the corresponding clinical syndromes in 24 patients. They were divided as following: 14 cases of insulinoma, 3 cases of Zollinger-Ellison syndrome, 1 case of glucagonoma, 1 case of carcinoid syndrome and 5 cases without any obvious endocrine manifestations. Each tumor was tested with anti-insulin, anti-glucagon, anti-pancreatic polypeptide, anti-vasoactive intestinal peptide, anti-gastrin immune sera according to the peroxidase-antiperoxidase method. The presence of insulin was proved in 13 of 14 cases of insulinomas and the presence of gastrin in 2 of 3 cases of Zollinger-Ellison syndrome. Among the 5 asymptomatic cases, a somatostatinoma and a vipoma were individualized. More than 50 p. 100 of the tumors showed plurihormonal secretion with one predominantly secreted hormone responsible for the clinical syndrome. This study demonstrated the diversity of the hormonal secretion by some tumors and their metastasis in the same patient. Malignant insulinomas correspond either to poorly secreting tumors or to plurihormonal tumors secreting gastrin and glucagon as well.