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Biomedical subjects

M Barthet

Publications and source records attributed to M Barthet.

At least 55 records · Page 3Linked to original sources
PubMed1997

Frequency and risk factors of recurrent pain during refeeding in patients with acute pancreatitis: a multivariate multicentre prospective study of 116 patients.

BACKGROUND/AIMS: The period of refeeding in patients with acute pancreatitis is critical because they may have pain relapse. A multicentre, multidimensional, prospective study was performed to assess the frequency and the risk factors of pain relapse in these patients. METHODS: Patients were included if they had acute pancreatitis severe enough to stop oral feeding for more than 48 hours. Clinical, biochemical, radiological, and therapeutic data were prospectively recorded and analysed by unidimensional and multidimensional analysis. The moment to refeed patients was chosen by the clinician but the diet was the same in all centres. RESULTS: A total of 116 patients were included with a Ranson's bioclinical score > or = 3 in 35% and a Balthazar's CT score > or = D in 42%. The cause of acute pancreatitis was biliary in 47% and alcohol misuse in 31%. During the oral refeeding period, 21% of the patients had pain relapse. This occurred on days 1 and 2 in 50% of patients. The duration of the painful period was longer in patients who relapsed than in others (p < 0.002). Pain relapse occurred in 39% of patients with a serum lipase concentration > 3x the upper limit of the normal range the day before refeeding and in 16% of other patients (p < 0.03). Patients with higher Balthazar's CT scores had pain relapse more often than the others (p < 0.002). None of the therapeutic procedures significantly modified the frequency of pain relapse. Using multidimensional analysis, Balathazar's CT score, period of pain, and serum lipase concentration the day before refeeding were independently associated with an increased risk of pain relapse. At a threshold of 0.5, a logistic score had a 37% sensitivity, 95% specificity, and 83% accuracy to predict pain relapse. Pain relapse nearly doubled total hospital stay and hospital stay after the first attempt at oral refeeding. CONCLUSION: Pain relapse occurred in one fifth of the patients with acute pancreatitis during oral refeeding and was more common in patients with necrotic pancreatitis and with longer periods of pain. The results of this study can be used to predict high risk patients and are a first step in the prevention of pain relapse.

Acute Disease↗
PubMed1996

[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↗
PubMed1996

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↗
PubMed1996

[Adenoma of Brunner's gland: a rare cause of duodenal obstruction].

Pseudo-tumoral hyperplasia of the Brünner glands is an exceptional dysembryoplastic or hyperplastic lesion which develops in the submucosa of the supra papillary proximal duodenum. We report a case of Brünner adenoma which led to duodenal obstruction. In 50% of the cases, the adenoma was asymptomatic but non-specific signs may lead to barium studies. CT scan of the abdomen or esogastroduodenal endoscopy which rarely provides formal histological proof. Major complications (hemorrhage, duodenal obstruction) and lack of formal diagnosis often leads to surgery, ideally with tumor resection after duodenotomy. Other prodecures (simple observation, endoscopic polypectomy, duodenopancreatectomy, biliary or digestive bypass without tumorectomy) may be entertained depending on the functional status, the volume of the tumor, presence of complications and overall general status.

Adenoma↗
PubMed1996

[Palliative treatment of esophageal neoplastic stenosis using bipolar electrocoagulation probe].

OBJECTIVE, PATIENTS AND METHODS: The objective of this study was to evaluate the results of palliative bipolar electrocoagulation probe (BICAP) treatment in 26 patients with non surgical, obstructive esophageal cancer. The mean tumor length was 7.2 cm. The strictures were located as follows: 3 in the cervical esophagus, 8 in the thoracic esophagus, 13 in the distal third of the esophagus and 2 involved both the cervical and thoracic esophagus. Most lesions were circumferential (73% versus 27% non circumferential) and exophytic (78% versus 22% sub mucosal). Coagulation was carried out under direct endoscopic control in the forward direction. The success of treatment was evaluated on the basis of the degree of reopening achieved (easy passage of an endoscope 12 mm in diameter) and good functional results (improvement of dysphagia, scored from 0 to 4 using a standard grading scale, for more than 15 days). RESULTS: Twenty-six patients underwent a total of 45 BICAP treatments (31 initial sessions, 14 repeated sessions). Reopening was achieved in 92% of cases and good functional results were obtained in 85% (mean dysphagia score: 3.2 before treatment versus 1.1 after treatment). The improvement of dysphagia resulted in a significant improvement of general performance status and stabilization or weight improvement in 21 patients. The mean number of sessions necessary for good initial results was 1.2 +/- 0.4. After the initial treatment by BICAP, radiotherapy or radiochemotherapy were respectively associated in 4 and 10 patients. The median duration of improvement was significantly longer in patients who underwent radiochemotherapy as compared with patients treated by BICAP alone (22 weeks versus 4 weeks). During the follow-up, 9 patients required several BICAP treatments and at the end of their disease, 12 patients underwent other palliative procedures. Major complications occurred in 4 cases (2 esotracheal fistulas, 1 hemorrhage, and 1 aspiration pneumonia) and mortality related to the procedure was 8%. CONCLUSIONS: Palliative BICAP treatment of obstructing esophageal and cardial cancer provide quick relief of dysphagia but repeated treatment sessions are necessary to maintain initial improvement. The procedure requires a short hospitalization stay and can be easily accomplished in all cases regardless of the tumor features.

Aged↗
PubMed1996

[Pancreatic and duodenal somatostatinoma. Two clinico-pathologic entities].

Somatostatinomas are endocrine tumors with predominant secretion of somatostatin. The majority occur in the pancreas and the duodenum. However, distinctive clinico-pathologic features are reported for both of them. The features of pancreatic somatostatinomas are a larger size, a more frequent clinical expression, a female predominance and a poorer prognosis. Duodenal somatostatinomas are characterized by psammoma bodies at histologic examination. We report here two cases of pancreatic and ampullary somatostatinomas, focusing on the main diagnostic problems and on the characteristics of each tumoral localization.

Aged↗
PubMed1995

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↗
PubMed1995

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↗
PubMed1995

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↗
PubMed1995

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↗
PubMed1995

[Influence of age and biliary lithiasis on the diameter of the common bile duct].

OBJECTIVE: To determine the influence of age and biliary lithiasis in the dilatation of the biliary ducts, a retrospective analysis was performed of the cholangiograms obtained by endoscopic retrograde cholangiopancreatography in patients presenting or with a past-history of biliary lithiasis and in controls. METHODS: Among 165 patients, 113 had choledocolithiasis (53 had gallstones, 50 had been cholecystectomized and 10 had no gallstones), 35 had gallstones and 17 had been cholecystectomized for gallstones. RESULTS: The diameter of the main biliary duct was significantly increased in the presence of common bile duct stones (14.0 +/- 4.9 mm), in cholecystectomized patients (11.7 +/- 4.3 mm), in presence of gallstones (9.2 +/- 2.4 mm). The diameter of the biliary ducts was significantly correlated with age in patients (r = 0.27; P = 0.001) and in controls (r = 0.31; P = 0.02). The different factors related to the dilatation of the main biliary duct were classified using a stepwise discriminant analysis: 1: choledocolithiasis, 2: age, 3: cholecystectomy, 4: gallstones. CONCLUSION: There is a moderate but significant statistical correlation between age and the dilatation of the common bile duct, independent of the presence of biliary lithiasis.

Adult↗
PubMed1994

Biliary stenting in benign biliary stenosis complicating chronic calcifying pancreatitis.

This a retrospective study of 19 patients presenting with chronic pancreatitis and benign stenosis of the common bile duct, who were followed up for periods ranging from 13 months to 48 months after biliary stenting (average 18 months). There were 18 men and one woman, aged between 38 and 65 years (average 49 years). The mean duration of the disease before stenting was seven years (range 1-25 years). Symptoms were present in ten patients: obstructive jaundice in four cases, cholangitis in three cases, and biliary colic in three cases. Nine patients without clinical complaints presented with chronic cholestasis. Endoscopic retrograde cholangiopancreatography (ERCP) showed 15 long, regular stenoses of the intrapancreatic course of the common bile duct, three short stenoses located at the upper margin of the head of the pancreas, and one biliary stenosis associated with peripheral compression by a cyst of the head of the pancreas. Forty endoscopic biliary stenting procedures were performed in the 19 patients over a six-year period. Successful insertion of the prosthesis was achieved in 39 cases. Two complications occurred: one duodenal ulceration and one stent migration into the bile duct. The mean duration of biliary stenting was ten months. Only two patients (10%) had complete clinical, biological, and radiological recovery. Complete failure of biliary stenting was observed in six patients (31%). Eleven patients (59%) had partial results: six (31%) had biological improvement although the biliary stricture persisted, and five were clinically asymptomatic but had cholestasis, and still presented with biliary stenosis in four cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Spontaneous intramural hematoma of the esophagus. Apropos of a case].

The authors report a case of spontaneous intramural haematoma of the oesophagus. This is a rare observation which usually occurs in association with oesophageal hyperpressure and sometimes with impaired haemostasis. The strategy for diagnosis is based on tomodensitography and also endosonography and magnetic resonance imagery.

Aged↗