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Biomedical subjects

L Bresler

Publications and source records attributed to L Bresler.

At least 55 records · Page 3Linked to original sources
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↗
PubMed1991

[Mesenteric and portal vein thrombosis following splenectomy in hematologic diseases. Apropos of 3 cases].

Mesenterico-portal venous thrombosis following hematological splenectomy is infrequent. We report about three cases successfully treated with heparin. A review of the literature allows identifying three factors acting in the etiopathogenesis of such thrombosis: alteration of blood composition, blood stasis and injuries to the vascular walls. The diagnosis is confirmed by ultrasonography and abdominal CT, and echo-Doppler will play a more important role in the future. The treatment of mesenterico-portal thrombosis is mainly medical, with surgery being indicated only in case of intestinal necrosis. An anticoagulant or platelet-suppressive treatment and the ligation of the splenic vein as close as possible to its junction with the mesenteric vein may be proposed as preventive measures.

Hematologic Diseases↗
PubMed1991

Pancreatic islet cell carcinoma with hypercalcemia: complete remission 5 years after surgical excision and chemotherapy.

A 45-yr-old man who presented with hypercalcemia was found to have an abdominal mass that was a pancreatic islet cell carcinoma. Although clinical features were suggestive of primary hyperparathyroidism, his parathyroid hormone level was not elevated. The patient underwent a radical resection of the pancreatic neoplasm which was situated in the tail of the gland. After surgery, the serum calcium fell within the normal range, suggesting that the tumor was responsible for production of a parathyroid hormone-like substance. Because of malignant histologic features of the lesion, a chemotherapeutic regimen including 5-fluorouracil and streptozotocin was indicated. Five years later, the tumor has remained in total remission.

Adenoma, Islet Cell↗
PubMed1989

[Stenosing and perforated ulcers of the small intestine related to potassium chloride in enteric-coated tablets. Apropos of 11 cases].

The enteric coated KCl tablet formulation generates complications that affect selectively the small intestine. A novel 1 g KCl tablet preparation proved to be accountable for the development of a specific type of intestinal disease. 11 cases of stenotic ulcers of the proximal ileum have been treated at the Clinique chirurgicale "C" (CHRU, Nancy) since January 1986, 9 of them presenting with perforations. These 11 patients required potassium replacement, which was being supplied by the same tablet formula. A study of these 11 cases focusing on the patients history and clinical characteristics was carried out, that included both macroscopic and microscopic examinations of the lesions. Arterial and venous networks were visualized by X-ray in two surgical tissue specimens, respectively, following injection of contrast material. The authors were thus able to bring forth evidence of the clinical uniqueness (prodromal pain reminiscent of König's syndrome and peritonitis characterized by asthenia); to identify the main risk factor (i.e., reduced bowel movement); as well as describe the basic lesion (pylorus-like stenosis), and propound a novel theory concerning the etiology and the pathology of this condition. The observation of the aforementioned cases initiated a nation-wide, post-marketing pharmacological survey, which resulted, as did a similar investigation which had been carried out in the States, in the discontinuation of any treatment by this type of galenic form of the product.

Adult↗