Search PubMed⌕ Search

Biomedical subjects

L Bresler

Publications and source records attributed to L Bresler.

At least 19 recordsLinked to original sources
PubMed1999

Vascular endothelial growth factor gene and protein: strong expression in thyroiditis and thyroid carcinoma.

Angiogenesis is implicated in several pathological conditions, such as inflammation and tumor growth. Vascular endothelial growth factor (VEGF), also known as vascular permeability factor, is a potent stimulator of endothelial cell proliferation in vitro and in vivo. The present work aimed to compare VEGF expression in human normal thyroid glands, thyroiditis tissue and thyroid carcinomas using immunohistochemistry and in situ hybridization (ISH). Both chronic lymphocytic thyroiditis and differentiated thyroid carcinomas were found to strongly express VEGF mRNA and encode larger amounts of VEGF than normal thyroid tissue as attested by a VEGF immunostaining score. In addition, tumor samples from patients with metastases showed a higher immunostaining score than their non-metastatic counterparts (P<0.05). Carcinomas with the greatest contents of VEGF mRNA and VEGF protein had the most intense mitogenic activity. Special focus on endothelial cells showed intense mitogenic activity in neoplastic tissues in contrast to the total quiescence of endothelial cells in non-tumoral tissues. An intense VEGF production by differentiated thyroid carcinoma, attested either by a higher immunostaining score or a strong VEGF mRNA expression using ISH, could be a promising marker of tumor aggressiveness and may also be useful as a predictor of metastatic potential.

Adult↗
PubMed1998

[The role of percutaneous drainage in acute calculous cholecystitis. Apropos of 27 cases].

Surgery is the treatment of acute calculous cholecystitis. Mortality and morbidity are considerable for patients with anesthetic risk factors. In this context, ultrasound-guided percutaneous drainage seems to be a alternative to urgent surgery. The place of this technic and its results have not been determined with certainty. We report our experience of percutaneous drainage in acute calculous cholecystitis, based on a series of 27 patients treated between May 1992 and May 1996. A favorable course was observed after drainage in 26 patients, one patient was operated urgently for purulent peritonitis on D1. One drain migrated into the gallbladder and required cholecystenterostomy en D30. Seventeen patients underwent cholecystectomy after the acute episode. Surgery was contra-indicated in light patients: two presented recurrence of acute calculous cholecystitis and six remained asymptomatic. The aim of this study was to define the place of this technic in the treatment of acute calculous cholecystitis, and estimate the results in terms of mortality, morbidity and recurrence.

Acute Disease↗
PubMed1996

[Adrenalectomy by posterior approach for benign adrenocortical tumors. Apropos of 12 cases].

The posterior extra-peritoneal route is usually preferred for exeresis of benign tumors of the adrenal glands measuring less than 5 cm. We examined the hospital reports for patients in which Young access was used since 1985. From December 1985 to December 1994, 12 patients underwent surgery for benign tumor of the adrenal gland. There were 9 women and 3 men (mean age 49.4 years, range 29-67). In all patients, the tumor was localized pre-operatively on a CT-scan. There was a unique tumor in each case. There were 11 adrenal adenomas including 10 Conn tumors and 1 secreting tumor (Cushing's syndrome). The last case was a cortical cyst. One patient died in the post-operative period, probably due to massive pulmonary embolism although necroscopic evidence was not obtained. Parietal infection occurred in one case and a spontaneously regressive hematoma in another. Mean duration of hospitalization was 7.0 days. At follow-up, 1 patient suffered deinnervation of the oblique muscles of the abdomen which did not require reoperation. Two months after surgery, clinical signs and hormone disorders related to the Conn adenomas had regressed in 7 of the 9 patients. In summary, the posterior route is perfectly adapted to the treatment of benign tumors of the adrenal glands when the exact localization can be identified on pre-operative imaging. This access should be considered as the reference route of evaluating laparoscopic procedures.

Adrenal Cortex Neoplasms↗
PubMed1995

[Intestinal resection in the treatment of Crohn disease. Retrospective study of a series of 106 cases].

Crohn's disease needs medical and surgical management. Most patients are operated and surgical procedure the most often realised is intestinal resection. The authors report their experience of 106 intestinal resection performed between 01/01/1980 and 31/12/1992, in the "service de Chirurgie C" of the "CHU de Nancy" for patients operated for the first time for Crohn's disease. They were 54 men and 52 women with an average age of 31.7 years at operative time. The following clinical patterns were established: small intestine 36, colonic 10 and ileocolic 60 patients. The average length of evolution before surgery was 4.5 years. The main indication was intestinal obstruction in small intestine patterns (91%) and poor response to medical therapy in colonic patterns (30%). Usual surgical procedure was to remove all visibly diseased bowell with healthy margin of resection, as judged by gross examination, of 3 to 5 cm. Postoperative morbidity was low (17.9%) with 3 anastomotic leakages. Postoperative morbidity was 1.9% (2 patients). The average duration of follow-up was 4 years. Among the 106 patients operated for the first time for their Crohn's disease, 19 (18%) were operated again, at least one time, during the follow-up. The quality of life of operated patients is considered as good with only one patient very invalidated by a short small bowel syndrome. According to the data of their series and the literature, the authors conclude that in Crohn's disease, excisional surgery is able to improve patients clinical status account to a low morbidity and mortality, with a low risk of short small bowel syndrome as clinical course but it does not avoid recurrence.

Adolescent↗
PubMed1995

Actinomyces naeslundii, acute cholecystitis, and carcinoma of the gallbladder.

This report describes the first case of biliary actinomycosis associated with an adenocarcinoma of the gallbladder. Actinomyces naeslundii was encountered as a pure isolate after a precise and careful identification. Although, in diagnosis, cancer and actinomycosis are often confused, the simultaneous occurrence of actinomycosis in cancer lesions can happen. This case illustrates the diagnostic challenge of actinomycosis.

Actinomyces↗
PubMed1995

[Imaging of severe forms of hematoma in the rectus abdominis under anticoagulants].

AIM: To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy. MATERIALS AND METHODS: CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed. RESULTS: All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted. CONCLUSION: Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.

Aged↗
PubMed1995

[Splenectomy under celioscopy].

Laparoscopic splenectomy has been extensively developed since its first description by Delaître in 1991. From May 1993 to July 1994, 12 patients underwent laparoscopic splenectomy in the "service de Chirurgie C" of the "CHU de Nancy". Six of them were successful. 6 women with a mean age of 27.7 years. The mean operating time was 2 h 30 min. For all cases, the indication was idiopathic thrombocytopenic purpura. No mortality and no morbidity was reported. One patient needed a blood transfusion. The postoperative stay ranged from 3 to 7 days. Splenectomy appears to be another procedure that may be successfully performed under laparoscopic guidance with satisfactory conditions of safety. The outcome evaluation should be continued in order to accurately define the real advantages and risks of this new technique.

Adolescent↗
PubMed1995

[Results of a controlled trial comparing 3 suture threads at slow resorption for the closure of supra-umbilical midline laparotomies].

A randomized prospective trial was carried out between September 1987 and February 1989 to compare 3 different absorbable sutures (polyglactine 910, polydioxanone I, polydioxanone II) for closure of the abdominal wall after upper midline laparotomy for elective operations. The technique used to close the fascia was always a continuous suture. The criteria used to assess the results were the development of wound infection and wound dehiscence in the early postoperative period, and the development of suture sinuses and incisional hernia 1 year after operation. The early postoperative results in 235 patients revealed no wound infection and no -wound dehiscence. Suture sinuses developed in 4 patients (2%) 2 months after operation, but resolved spontaneously. We reviewed 203 patients after one year. The total number of incisional hernias detected 1 year postoperatively was 22 cases (11%), (polyglactine 910, 14.2%; polydioxanone I, 11.2%; polydioxanone II, 8.4%). The difference between the 3 groups was not statistically significant. The results of the trial indicate that absorbable sutures have a very low incidence of suture sinuses, and that polydioxanone II seems to be a good choice for closing laparotomies.

Adult↗
PubMed1995

[Celioscopic treatment of acute obstructions caused by adhesions of the small intestine. Experience of 35 cases].

Postoperative adhesions are the primary cause of occlusion of the small bowel. We evaluated the feasibility and the immediate postoperative results of laparoscopic procedures for acute adhesions on the small bowel. Between September 1992 and March 1995, we performed laparoscopic procedures in 35 patients with acute occlusion of the small bowel. The preoperative work-up highly suggestive of adhesion. There were 17 males and 18 females, mean age 48.2 years. In 30 patients, the operation confirmed the preoperative diagnosis of occlusion by adhesions. Lysis was performed entirely via the laparoscopic route in 21 of the 30 patients (70%). Immediate postoperative complications were 3 bowel lesions. Intestinal mobility was re-established in 1.8 days after operation and the mean duration of hospitalization was 5 days for patients with laparoscopic procedure alone compared with 3.4 days for intestinal mobility and 10.4 days hospitalization for the 9 patients who were converted to laparotomy. An eventration of the trocar orifice occurred late in one patient and ischaemic stenosis of the bowel required laparotomy in another. There were no deaths. Laparoscopic treatment of adhesion occlusions is a feasible operation. Morbidity is low in experienced hands. The immediate benefit is rapid intestinal mobility and shorter hospital stay. The effect on long-term risk to be evaluated.

Acute Disease↗
PubMed1994

A surgical model for studying biliary excretion of drugs in the awake micropig yucatan.

The pig is probably one of the best mammalian models for studying the digestive functions and the biliary excretion of drugs because of the tight similarities with humans. Insertion of a T drain in the common bile duct after cholecystectomy in humans became uncommon because of surgical progress. For this reason, we developed a model using a bidirectional cannula to study the biliary secretion in the conscious Micropig Yucatan. We used this breed because of their ready availability and low stable weight. The surgical procedure was a double choledococholedocal fistula with a bypass on the main biliary duct, maintaining the continuous flow of bile into the duodenum through the sphincter of Oddi. This fistula remained effective for at least sixty days with normal hepatic biologic parameters. The development of our model could improve the biliary excretion study of drugs. Comparison of different routes of administration and interaction pharmacokinetic studies could also be studied in the same micropig, eliminating intersubject variations.

Animals↗
PubMed1993

Biliary elimination and pharmacokinetics of vinorelbine in micropigs.

The biliary elimination and pharmacokinetics of vinorelbine (NVB) were investigated in five conscious micropigs provided with a double-terminal choledocal fistula allowing the collection and reinstillation of bile. After the i.v. administration of NVB (0.5 mg/kg), serum and bile samples were collected over a 48-h period. The concentrations of NVB were measured by high-performance liquid chromatography. The serum concentrations decreased rapidly from a maximal value of 208.6 ng/ml (SD, 111.7 ng/ml). The mean half-life was 10.9 h (SD, 8.6 h) and the mean AUC0-48 h was 292.8 ng ml-1 h (SD, 79.4 ng ml-1 h). The bile concentrations were high, amounting to 16.0 micrograms/ml (range, 5.4-27.7 micrograms/ml). The 0- to 48-h biliary excretion of unchanged NVB accounted for 25.8% (SD, 5.7%) of the injected dose, with 21.5% (SD, 4.0%) being eliminated during the 0- to 8-h period. Desacetyl-NVB was found in an inconstant manner and in very low amounts in bile samples. In addition, no glucuronide of NVB could be detected. Thus, in the micropig, biliary excretion represents an important route of elimination for NVB.

Animals↗
PubMed1992

Villous adenomatosis of duct of Wirsung revealed by wirsungorragie: evolution and surgical management.

A patient presenting with wirsungorragie was found to have a villous adenoma of the duct of Wirsung. The lesion was treated by a left pancreatectomy. Five years later he presented with recurrent wirsungorragie and was found to have a villous adenomatosis of the main pancreatic duct and of its side branches. This time a Whipple procedure was performed, achieving a total pancreatectomy. The patient has remained well for 12 months. This case of villous adenomatosis is, to our knowledge, the first one to be revealed by a wirsungorragie.

Adenoma↗
PubMed1992

Pharmacokinetics and biliary elimination of temafloxacin in pigs.

The purpose of the present work was to investigate the 48 h pharmacokinetic and biliary elimination of temafloxacin, administered intraduodenally at a single dose of 10 mg/kg to six conscious pigs provided with a double terminal choledocal fistula allowing the collection and the reinstillation of bile. The concentrations of temafloxacin in biological fluids were measured by both HPLC and bioassay. The mean serum half-life of temafloxacin was 11.45 +/- 4.4 h and the apparent oral clearance (assuming a 95% bioavailability) was 171 +/- 66 mL/min. The penetration of temafloxacin into bile is significant as indicated by a bile/serum AUC ratio of 9.1 +/- 2.2. The 0-45 h biliary excretion amounted to 2.002 +/- 0.8 mg, representing 0.9 +/- 0.3% of the administered dose. Biliary peak concentrations ranged from 8.0 to 37.5 mg/L and the 24 h mean biliary concentration was 3.7 +/- 2.4 mg/L. No statistically significant differences between HPLC and bioassay concentrations or AUCs could be observed in bile, indicating that temafloxacin is not extensively biotransformed into active metabolites in this model. These data, together with data in man, suggest that temafloxacin could be a useful agent for the treatment of biliary tract infections.

Animals↗
PubMed1992

Effects of diclofenac on ceftriaxone pharmacokinetics in humans.

The effects of diclofenac, a nonsteroidal antiinflammatory drug, on the biliary and urinary excretion of ceftriaxone were evaluated in subjects with a T drain in the common bile duct. The kinetic study was carried out on the sixth postoperative day of treatment with ceftriaxone alone (2 g intravenously; group 1) or ceftriaxone combined with diclofenac (50 mg every 12 h orally from postoperative days 3 to 6; group 2). A significant increase in the elimination half-life of ceftriaxone was observed in group 2 patients. Diclofenac caused a significant rise in ceftriaxone biliary excretion. This increase was not sufficient to balance the significant deficit of urinary excretion of ceftriaxone.

Aged↗
PubMed1991

[Bacteriological aspects of acute cholangitis with gallstones].

The bacteria found in the bile and blood of 45 patients (27 men, 18 women; mean age 69 years) suffering from acute cholangitis with gallstones were studied in order to determine the appropriate antibiotic therapy. Before any antibiotic was prescribed, a series of haemocultures was performed under aerobic and anaerobic conditions, and later gallbladder bile samples were taken during the operation. Blood cultures were positive in 55 percent of the cases and bile cultures in 84 percent. The bacteria most frequently encountered in blood were Escherichia coli, Klebsiella spp. and Bacteroides fragilis. The frequency of bacteria passage from bile to blood was studied and clearly showed a predominance of E. coli, Klebsiella and anaerobes. Enterococci passed into the blood stream only in very special circumstances, such as endoscopic sphincteromy or inadequate antibiotic therapy. To be effective, the antibiotic treatment should cover enterobacteriaceae, anaerobes and, if required, staphylococci. Enterococci can be ignored in most cases.

Acute Disease↗