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Biomedical subjects

M Barthet

Publications and source records attributed to M Barthet.

At least 37 records · Page 2Linked to original sources
PubMed2001

Intraductal papillary or mucinous tumors (IPMT) of the pancreas: report of a case series and review of the literature.

OBJECTIVE: Despite a better understanding of these conditions, intraductal papillary or mucinous tumors (IPMT) of the pancreas still present difficulty relating to the predictive factors of malignancy and the risk of relapse after surgical resection. The aim of this study was to report on our experience and to compare it to previously published cases. METHODS: We studied retrospectively 26 patients (mean age 60.3 yr) presenting with IPMT. Of the 26 patients, 19 had surgical resection and seven did not. The main clinical feature was acute pancreatitis occurring in 38% of the patients. Segmental pancreatectomy was performed in all the cases. At pathological assessment of resection margins, tumor resection was considered as complete in 17 cases. Margins exhibited benign mucinous involvement, and resection was considered to be incomplete in one multifocal case and in one case with diffuse spread of the tumor. RESULTS: A total of 11 tumors were benign and five were malignant. Carcinomas were invasive in four cases (two invading the pancreatic parenchyma, one the duodenum, and one the peripancreatic nodes) and in situ in one case. Malignancy was not diagnosed preoperatively except when invasion was evident (duodenal spread). Although main pancreatic duct type and obstructive jaundice appeared as suggestive features for the risk of malignancy, no reliable preoperative predictive factors for malignancy could be identified as regarding to clinical parameters, biological examinations, carcinoembryonic antigen or CA19-9 levels in serum or in pure pancreatic juice, imaging, and cytological methods. Within 40.8 months mean follow-up after surgery (range 2-96 months), three patients (16%), two with malignant and one with benign tumor, had tumor relapse after respectively 7, 27, and 14 months. Margins were positive without malignant features in the two malignant cases and negative in the other case. Tumor relapse was malignant with diffuse spreading in the three cases, and the patients died within 34 months after surgical resection. CONCLUSIONS: Our series and the review of the literature indicate that preoperative indicators of malignancy in IPMT are still lacking. Concerning resection margins, complete tumor resection is usually possible by segmental pancreatectomy. Malignant relapses are not exceptional. Incomplete resection and diffuse or multifocal tumor represent poor prognostic factors. Total pancreatectomy should be considered in such cases.

Adenocarcinoma, Mucinous↗
PubMed2001

[Infliximab therapy for Crohn's disease anoperineal lesions].

AIM OF THE STUDY: To retrospectively evaluate the efficacy, the duration of response, and the tolerance of Remicade in anoperineal Crohn's disease. METHODS: Fifty patients with severe symptomatic and refractory anoperineal Crohn's lesions (38 fistulae and 29 cavitating ulcers and superficial fissures) were treated with 3 intravenous infusions of Remicade (5 mg/kg) at weeks 0, 2 and 6. Efficacy was assessed using Allan's functional score and proctologic examination at 8 weeks (W8) and 24 weeks (W24) after the first infusion. RESULTS: At W8, a response was noted for 71% (27/38) of fistulae and 79% (23/29) of ulcers and fissures. Healing rates were 39% and 49%, respectively. Efficacy of Remicade at W8 did not vary according to sex, number and type of fistulae and other treatments. At W24, 58% (15/26) of patients with fistulae and 63% (10/16) of patients with ulcers or fissures had a response. The response rate at W24 was higher in patients having anoperineal Crohn's lesions for less than one year: 77% vs 32% (P=0.004). Median Allan's score significantly decreased from 3.9 before treatment to 1.7 at W2 (P<0.001), 1.3 at W6 and 0.8 at W8. Median duration of response was 9.5 months (range: 0.5-12.5) after last infusion and was not influenced by associated treatments including immunomodulators. The relapse rate at 1 year was 64% for the responders followed at least one year (n=21). Minor adverse events occurred during 12% of all infusions. Eight patients had an infection, including one pneumonia. Eight patients developed a perineal abscess 16 weeks (range: 4-32) after the first infusion. CONCLUSION: Remicade is rapidly effective and well tolerated in anoperineal Crohn's lesions, but the high relapse rate stresses the need for long term therapeutic strategies in these patients.

Abscess↗
PubMed2000

Expression profiling in pancreas during the acute phase of pancreatitis using cDNA microarrays.

Most attacks of acute pancreatitis are self-limiting, suggesting that the pancreatic cells adapt their phenotype to prevent progression of the disease. Such phenotypic change must involve a coordinated modification in the expression of numerous genes. To identify differentially expressed genes, high-density mouse cDNA microarrays were hybridized with cDNA probes from both healthy pancreas and pancreas affected by acute pancreatitis. From the 7981 mouse genes analyzed, 239 showed significant changes in their expression during the acute phase of pancreatitis. Among them, 107 genes were up-regulated whereas 132 were down-regulated. They include genes whose function was not previously related to pancreatitis, suggesting that they are involved in some way into the acute pancreatic response. Finally, 40% of differentially expressed genes corresponded to ESTs. Demonstration that a large quantity of unexpected or yet uncharacterized genes showed altered expression during acute pancreatitis underscores the interest of a genome-based investigation. Some of these genes are certainly involved in the cellular defense against pancreatitis and, as such, deserve being studied further.

Acute-Phase Reaction↗
PubMed2000

[Pancreatic intubation ifn pancreas divisum].

AIM: Long-term results of endoscopic pancreatic stenting in pancreas divisum is still debated. The aim of this retrospective study was to evaluate the efficacy of dorsal duct stenting in patients presenting with acute recurrent pancreatitis. PATIENTS AND METHODS: Between 1980 and 1998, among 34 patients presenting with recurrent acute pancreatitis associated with pancreas divisum, 21 were treated by pancreatic stenting during a mean time of 11 months. There were 13 men and eight women (mean age: 50 years). RESULTS: The median follow-up was 50 (range 11-105) months. The number of patients presenting with acute pancreatitis before pancreatic stenting, at the end of stenting and at the end of the follow-up was respectively 21/21 (100%), 2/19 (10%) and 2/18 (11%) (P < 0.01). The number of patients presenting with chronic pain before stenting, at the end of stenting and at the end of the follow-up was respectively 17/21 (80%), 6/19 (31%) and 5/18 (27%) (P = 0.07). The overall morbidity rate was 8/21 patients (38%) including mainly acute pancreatitis (three cases); all but one complication were managed conservatively. CONCLUSION: In patients with pancreas divisum, dorsal duct stenting decreases the rate of recurrent acute pancreatitis but the improvement of chronic pain appears less obvious.

Acute Disease↗
PubMed2000

Dynamic anal endosonography may challenge defecography for assessing dynamic anorectal disorders: results of a prospective pilot study.

BACKGROUND AND STUDY AIMS: The diagnosis of anorectal dynamic disorders and perineal insufficiency has been mainly based up to now on the use of defecography. Here, we performed a prospective blinded study to evaluate the accuracy of a new procedure, dynamic anorectal endosonography (DAE), by comparing it with defecography. PATIENTS AND METHODS: A total of 43 women (mean age 53), presenting with outlet obstruction, were prospectively enrolled in our study. The DAE was performed with a 7.5-Mhz linear probe (Toshiba, Tokyo, Japan) with basal and straining recordings. None of the DAE or defecography operators was informed about the results of the respective other investigation. RESULTS: Defecography showed a descending perineum in 29 patients (68%), a rectocele in 25 patients (58%), and a rectal intussusception in eight patients (18%). The rate of concordance between the diagnosis of descending urinary bladder at DAE and descending perineum at defecography was 35/43 (80%), and that between the descending puborectal muscle at DAE and descending perineum at defecography was 40/43 (93 %). The rates of concordance between DAE and defecography for the diagnosis of rectocele and rectal intussusception were 27/43 patients (57%) and 34/43 patients (80%), respectively. In the last 15 patients, the DAE technique was adapted in order to improve the accuracy for diagnosing rectocele by filling the rectum with water. This improved sensitivity from 36 to 86% and accuracy from 57 to 87%. CONCLUSIONS: DAE is a new imaging approach to anorectal dynamic disorders, providing a highly reliable means of diagnosing perineal insufficiency as well as rectocele. DAE should be substituted for previous methods since it makes it possible at the same time to assess the anal sphincters and to avoid pelvic irradiation.

Adult↗
PubMed1999

Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn's disease.

BACKGROUND: Endosonography and magnetic resonance imaging (MRI) are promising methods for evaluating perineal and anorectal fistulas or abscesses. The aim of this study was to compare the results of anal endosonography (AES), MRI and surgical exploration in the assessment of anorectal fistula or abscess complicating Crohn's disease. METHODS: Twenty-two patients with Crohn's disease, seven men and 15 women of mean age 38 (range 17-67) years, were included in this prospective study. All patients underwent AES (linear probe 7 MHz), MRI and operative assessment. RESULTS: AES and MRI demonstrated 14 and nine abscesses respectively, whereas 11 abscesses were confirmed by surgical exploration in ten patients. The sensitivity of AES and MRI as means of evaluating anorectal abscesses was 100 and 55 per cent respectively. The agreement per patient was 86 per cent (19 of 22) for AES and 59 per cent (14 of 22) for MRI. AES and MRI demonstrated 26 and 14 fistulas respectively, whereas 27 fistulas were confirmed during surgical exploration in 16 patients. The sensitivity of AES and MRI was 89 and 48 per cent respectively. The level of agreement per patient was 82 per cent (18 of 22) for AES and 50 per cent (11 of 22) for MRI. CONCLUSION: AES with a linear probe is more accurate than MRI in detecting anorectal abscesses complicating Crohn's disease, and much more accurate in the evaluation of complex fistulas.

Abscess↗
PubMed1999

Chronic pancreatitis and inflammatory bowel disease: true or coincidental association?

OBJECTIVE: Several cases of pancreatitis have been described during the course of Crohn's disease (CD) or ulcerative colitis (UC), but many of them were related to either biliary lithiasis or drug intake. We tried to evaluate the clinical and morphological features of so-called idiopathic pancreatitis associated with inflammatory bowel disease and to define their pathological characteristics. METHODS: Chronic idiopathic pancreatitis was diagnosed on the basis of abnormal pancreatograms suggestive of chronic pancreatitis associated with or without impaired exocrine pancreatic function, or pathological examination in patients undergoing pancreatic resection. We found 6 patients presenting with features of chronic idiopathic pancreatitis and UC and 2 patients with CD seen between 1981 and 1996 in three hospital centers of the south of France. A review of the literature has identified 6 cases of pancreatitis associated with UC and 14 cases of pancreatitis associated with CD based on the above criteria. RESULTS: Hyperamylasemia was not a sensitive test since it was present in 44% and 64% of patients with UC or CD. In UC, pancreatitis was a prior manifestation in 58% of patients. In contrast, the pancreatitis appeared after the onset of CD in 56% of the cases. In patients with UC, pancreatitis were associated with severe disease revealed by pancolitis (42%) and subsequent surgery. Bile duct involvement was more frequent in patients with UC than with CD (58% vs 12%) mostly in the absence of sclerosing cholangitis (16% vs 6%). Weight loss and pancreatic duct stenosis were also more frequent in UC than in CD (41% vs 12% and 50% vs 23%, respectively). Pathological specimens were analyzed in 5 patients and demonstrated the presence of inter- and intralobular fibrosis with marked acinar regression in 3 and the presence of granulomas in 2 patients, both with CD. CONCLUSIONS: Pancreatitis is a rare extraintestinal manifestation of inflammatory bowel disease. Chronic pancreatitis associated with UC differs from that observed in CD by the presence of more frequent bile duct involvement, weight loss, and pancreatic duct stenosis, possibly giving a pseudotumor pattern.

Adolescent↗
PubMed1999

Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation.

BACKGROUND: Polyethylene glycol (PEG) 3350 is a non-absorbable, non-metabolised osmotic agent used in lavage solutions for gut cleansing. AIMS: To compare the efficacy of PEG and lactulose in chronic constipation. METHODS: A total of 115 patients with chronic constipation entered a multicentre, randomised, comparative trial. They initially received two sachets containing either PEG (13 g/sachet) or lactulose (10 g/sachet) and were given an option to change the dose to one or three sachets/day, depending on response. RESULTS: Ninety nine patients completed the trial. After four weeks, patients in the PEG group (n=50) had a higher number of stools and a lower median daily score for straining at stool than patients in the lactulose group (n=49). Overall improvement was greater in the PEG group. Clinical tolerance was similar in the two groups, but flatus was less frequently reported in the PEG group. The mean number of liquid stools was higher in the PEG group but the difference was significant only for the first two weeks. There were no serious adverse events and no significant change in laboratory tests in either group. At the end of the study, the number of sachets used by the patients was 1.6 (0.7)/day in the PEG group and 2.1 (0.7)/day in the lactulose group. Sixty one patients completed a further two months open study of one to three sachets PEG daily; there was no loss of efficacy and no serious toxicity. CONCLUSION: Low dose PEG 3350 was more effective than lactulose and better tolerated.

Adult↗
PubMed1999

[Pancreatic intubation by endoscopy in chronic calcifying pancreatitis].

BACKGROUND: The aim of our study was to assess the efficacy of endoscopic pancreatic stenting on pain and frequency of acute pancreatitis in patients with calcifying chronic pancreatitis. PATIENTS: Between 1987 and 1996, 70 patients underwent endoscopic management for calcifying chronic pancreatitis. RESULTS: Endoscopic stent placement was successful in 59 patients (85%). 46 patients were followed for a mean duration of 29 +/- 26.4 months after stent removal. The presence of pancreatic pseudocysts in 26 patients appeared to modify pain improvement rate but did not influence the decrease in the frequency of acute pancreatitis. An improvement of pancreatic pain occurred at the end of stenting and after removal of the stent in respectively 44% and 38% of the patients without pseudocysts and in 85% (P < 0.02) and 65% of the patients presenting with pancreatic pseudocysts. Before stenting, 43/70 (61%) patients had at least two episodes of acute pancreatitis. After removal of the stent, only 5/46 (11%) had one episode of acute pancreatitis. Improvement of weight loss and diabetes was observed in respectively 28 cases (52%), 7 cases (39%) at the end of pancreatic stenting and was still persisting in 21 (51%) and 5 cases (26%) after removal of the stent. CONCLUSION: After pancreatic stenting, the improvement of pain appears to be moderate in the absence of pancreatic pseudocyst. Nevertheless, the improvement of pain is maintained after stent removal. Moreover, the frequency of acute pancreatitis is significantly decreased after pancreatic stenting.

Adult↗
PubMed1998

Effects of trimebutine on sphincter of Oddi motility in patients with post-cholecystectomy pain.

BACKGROUND: Trimebutine is an opiate modulator of the gastrointestinal motility that interacts with enkephalinergic receptors. AIM: To evaluate the effects of trimebutine (50 mg intravenous injection) on the motility of the sphincter of Oddi (SO) as assessed by endoscopic manometry. METHODS: Endoscopic manometry was performed on 15 cholecystectomized patients who presented with symptoms suggestive of SO dysfunction. Prior to the endoscopic manometry, endoscopic ultrasonography was performed in order to rule out the possible presence of a bile duct stone. RESULTS: Injecting trimebutine resulted in a significant increase in the SO antegrade phasic contraction rate (P = 0.02). Trimebutine decreased the basal pressure of the SO (32.5 vs. 27.5 mmHg), but the difference is not statistically significant (P = 0.11). The effects of trimebutine differed depending on the basal SO motility anomalies involved, but the period of latency was similar (mean 89 s: range 30-240 s). The basal anomalies were an increased basal SO pressure of > 40 mmHg in three patients, a tachyoddia (frequency of phasic contractions (PC) > 10/min) in six patients, prolonged PC (> 10 s) in two patients and an absence of phasic contraction in one patient. The basal pressure of the SO decreased in the three patients presenting with SO hyperpressure, but returned to a normal value in one case. The frequency of the PC decreased to normal in three out of the six patients with tachyoddia. The duration of the PC returned to normal in the two patients with prolonged PC whereas their frequencies increased. Prolonged PC developed in the patient without any detectable phasic contraction. CONCLUSIONS: Trimebutine modulates SO motility in various ways depending on the basal SO motility anomaly observed after cholecystectomy. This regulatory effect suggests the existence of encephalinergic control of SO motility.

Adult↗
PubMed1998

Relationships between endosonographic appearan e and clinical or manometric features in patients with achalasia.

BACKGROUND: The existence of endosonographic abnormalities of the oesophagus in achalasia is discussed. The place of endoscopic ultrasonography (EUS) needs to be clarified. PATIENTS: Thirty five untreated patients suffering from achalasia and 28 controls without oesophageal disease were prospectively enrolled since 1993. Pseudoachalasia was diagnosed in two patients. METHODS: EUS measurements were performed at two opposite sites at the level of the cardia, and 5 cm and 10 cm proximally, avoiding compression by the water filled balloon. RESULTS: The oesophageal wall and the fourth hypoechoic layer were significantly thicker at the level of the cardia and 5 cm above, with mean differences between patients and controls of 0.37/0.42 mm and 0.16/0.23 mm respectively. No statistically significant correlation could be demonstrated between the thickness of the oesophageal wall or of the fourth hypoechoic layer and weight loss, or the average pressure of the lower oesophageal sphincter. However, a significant inverse relationship was demonstrated between the duration of symptoms and the thickness of the fourth hypoechoic layer. The thickness of the fourth hypoechoic layer was also increased in patients who required only one pneumatic dilatation (P < 0.01). CONCLUSION: The thickness of the oesophageal wall and of the fourth hypoechoic layer appeared to be significantly increased in achalasia patients. However, the slight increase of the mean size (< 0.5 mm) of the muscularis propria suggests that EUS is not helpful in the diagnosis of achalasia. The physiopathological basis of advanced achalasia has to be reconsidered as we demonstrated an inverse relationship between the duration of symptoms and the thickness of the muscularis propria.

Adult↗
PubMed1998

Eosinophilic pancreatitis mimicking pancreatic neoplasia: EUS and ERCP findings--is nonsurgical diagnosis possible?

Eosinophilic pancreatitis is a rare disease with, to date, only 10 reported cases. We report two patients whose presentation was suggestive of a pancreatic tumor. An 18-year-old man presented with a short history of obstructive jaundice, epigastric pain, and weight loss. Endoscopic ultrasonography revealed a 12-mm round, hypoechoic lesion in the head of the pancreas, suggestive of a pancreatic endocrine tumor. A duo-denopancreatectomy was performed, and the patient made an uneventful recovery. A 64-year-old man was referred with weight loss and obstructive jaundice due to a stricture of the common bile duct. Retrograde pancreatography demonstrated a very narrow, regular main pancreatic duct and early parenchymography. Endoscopic retrograde cholangiopancreatography revealed a tight, regular stenosis of the intrahepatic portion of the common bile duct. A gastrojejunal anastomosis and biliary-digestive bypass were performed without postoperative complications. In both cases, the diagnosis of eosinophilic pancreatitis was revealed after surgical resection. The features of eosinophilic pancreatitis, including eosinophilic infiltration of the digestive wall, a history of atopy, and the radiological characteristics are described. If these are of sufficient discriminatory value, unnecessary surgery may be avoided.

Adolescent↗
PubMed1998

[Familial varices of the colon. Report of four cases].

We report four cases of ileo-colonic varices in one family. This congenital disease is uncommon with only 21 cases described in the literature. Recurrent digestive tract bleeding is the most common manifestation, but varices can be asymptomatic. Digestive endoscopy leads to the diagnosis. The diagnosis of familial colonic varices can be considered when colonic varices occur in several members of a family with no evident cause, particularly portal hypertension or venous thrombosis. No treatment is usually necessary except when major or recurrent bleeding indicates surgical resection. These malformations are classified as vascular ectasia in the subgroup of cavernous haemangiomas.

Adolescent↗
PubMed1997

Pancreatic ductal changes in HIV-infected patients.

BACKGROUND: AIDS-related sclerosing cholangitis occurs in patients with advanced immunodeficiency, but ductal pancreatic alterations have not been evaluated in large series. METHODS: Twenty-nine consecutive patients with a mean age of 33 years underwent ERCP for biliary work-up. Complete pancreatography was obtained in 28 patients. Serum levels of amylase were increased in 17 patients prior to ERCP. The mean duration of HIV infection was 6.1 years (range 3 to 10 years). RESULTS: Fifteen patients (53.6%) had pancreatographic changes classified according to the Cambridge classification (stage 1, 4 cases; stage 2, 7 cases; stage 3, 4 cases). Dilatations, irregularities, short stenoses of the main pancreatic duct, and irregularities of side branches were the most frequent abnormalities. Fourteen of these 15 patients (93.3%) had cholangitis and a CD4 cell count of less than 60 per cubic millimeter. Risk factors for pancreatic damage were similar in patients with and without pancreatographic changes. Opportunistic infection occurred in 14 of 15 patients with pancreatographic changes (candida, cytomegalovirus, cryptosporidia, microsporidia, and mycobacteria). CONCLUSION: Abnormal pancreatographies were found in about half of the HIV-infected patients who underwent ERCP. The pancreatographic features were suggestive of chronic pancreatitis and were closely related to the presence of AIDS-related sclerosing cholangitis.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Radiolucent pancreatic lithiasis: a precursor stage for calcified pancreatic lithiasis or a new entity?

OBJECTIVE: Radiolucent pancreatic lithiasis (RPL) has been identified as a different entity from calcified pancreatic lithiasis. The purpose of this study is to evaluate the frequency, characteristics and evolution of RPL. PATIENTS: Between 1983 and 1995, 278 consecutive patients who presented with pancreatic lithiasis were studied. Forty-four patients had RPL (15.8%): 27 had pure radiolucent stones (PRS) (group 1), 5 had pure radiolucent stones combined with evenly calcified stones (ECS) (group 2), 2 had target calculi (TC) (radiolucent core with calcified shell) (group 3), 10 had TC combined with ECS (group 4). RESULTS: Among the 27 patients with PRS, there were 19 males with a mean age of 41 years. PRS were mainly located in the head of the pancreas with a mean diameter of 5 mm (range 3-26 mm). Seven patients among 27 with PRS (26%) were less than 20 years old (juvenile form) or more than 60 years old (senile form). They were characterized by no or low alcohol consumption and a high rate of attacks of acute pancreatitis. In group 1, PRS turned to more advanced calcified stages in 6/16 of patients (37%) followed in 30 to 144 months with a prior stage of TC in 2 cases. An evolution toward more calcified stages (TC or ECS) occurred in half of the patients belonging to group 2 and 4 in 36 to 84 months. Genetic disposition and alcohol consumption could account for the evolution toward more calcified stages. A genetic factor is suggested by a rapid evolution to evenly calcified stones in two aged children 8 and 10 years and by a high frequency of familial cases in patients belonging to groups 2 and 4 (60% and 20%) as compared to group 1 with PRS (4%). Alcohol consumption could accelerate the calcifying process since patients belonging to groups 2 and 4 had a significantly higher alcohol consumption than those with PRS (group 1). CONCLUSION: RPL is a heterogeneous pancreatic disease including juvenile and senile presentation which may represent about 15% of pancreatic lithiasis. Evolution towards calcified stages (PRS then TC then ECS) occurred in 37-50% of cases and could be related to a genetic factor and increased alcohol consumption.

Adolescent↗