Search PubMed⌕ Search

Biomedical subjects

M Cremer

Publications and source records attributed to M Cremer.

250 records · Page 14Linked to original sources
PubMedDate not supplied

[Complementarity and limits of the different technics of pancreatic morphologic investigation for the diagnosis of acute pancreatitis and complications (author's transl)].

The authors have previously proposed the endoscopic retrograde cholangio-pancreatography as a technic to be used systematically in acute pancreatitis; it offers a precise diagnosis of microlithiasis and a possibility of an immediate endoscopic treatment. They have studied the pancreatographic patterns in 355 cases of clinical acute pancreatitis; the pancreatogramm allows the diagnosis of chronic pancreatitis in acute phase in 1/3 of the patients; necrosis is present in 12% of the 240 patients without any radiological signs of chronic pancreatic disease. The computerized axial tomography gives a precise definition of the extra-pancreatic extension of the necrosis; the ultra-sound technic is better for the late complications of acute pancreatitis. The authors consider that these 3 examination technics must be performed at the admission or/and be part of the workup before surgery.

Acute Disease↗
PubMedDate not supplied

[Acute necrotizing pancreatitis. Large bowel complications (author's transl)].

Fifteen large bowel lesions are reported among 12 patients with acute necrotizing pancreatitis: 6 stenosis (transient in one case), 5 necrosis and 4 perforation. In 7 cases out of 12, abdominal plain film was suggestive of colonic involvement. Barium enema and coloscopy may confirm the diagnosis. Previously reported cases (56 stenosis, 84 perforations, 35 necrosis) are reviewed and clinical course radiographic features and the results of surgical management are discussed.

Acute Disease↗
PubMedDate not supplied

[Interest of bilio-pancreatic morphologic study in management of acute pancreatitis (author's transl)].

The interest of morphologic investigations in the diagnosis, the prognosis and the treatment of acute pancreatitis was analyzed in a series of 120 patients. The systematic endoscopy of the biliary tract yields a distinction between the biliary and the non-biliary sources of pancreatitis and can be followed immediately by an endoscopic sphincterotomy. Th morphological study of the bilio-pancreatic area can complete the prognostic indexes defined by the clinical and biological data, document the extension of the intra- and extrapancreatic necrosis and precise the indication and the choice of a surgical treatment.

Acute Disease↗
PubMedDate not supplied

The role of infectious agents in Crohn's disease.

Environmental factors certainly play a role in the appearance of Crohn's disease. Wether or not those factors are infectious agents remains uncertain. Broadly, two classes of infectious hypothesis are currently under investigation. The first one, concerning specific microorganisms (such as mycobacteria and virus) dates back to the first description of the disease in 1913. The second one studies the possible involvement of compounds derived from the intestinal microflora, irrespective to speciation. It appeared more recently and receives more and more attention. These hypothesis are reviewed by the authors with regard to data obtained from epidemiology, clinical and experimental investigations.

Crohn Disease↗
PubMedDate not supplied

Chronic hereditary pancreatitis.

Chronic hereditary pancreatitis is a rare disease accounting for 0.9% of chronic pancreatitis cases. Onset is at an earlier age than chronic alcoholic pancreatitis, often with recurrent painful episodes in childhood. We report the occurrence of hereditary pancreatitis in 3 members of a family over 3 generations.

Adenocarcinoma↗
PubMedDate not supplied

Endoscopic varix ligation: a promising new technique?

Endoscopic varix ligation is a new promising endoscopic method which compete with endoscopic sclerotherapy both during acute bleeding and the chronic setting where the aim is to obliterate varices as soon as possible with minimal side effects.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Endoscopic management of chronic pancreatitis.

The indications of endoscopic management for chronic pancreatitis are strictly related to the classification of severe types and to the particular anatomy of the ducts: 1. Impacted or distal calculi: endoscopic pancreatic sphincterotomy (EPS) alone followed by ESWL when extraction fails. 2. Stone(s) and stricture: EPS, ESWL, NPC, and then 10F plastic stenting. 3. Relapsing strictures (with upwards dilatation) after 6 to 12 months stenting: silicone covered self expanding stent in a trial, versus surgical pancreaticojejunostomy. 4. Paraduodenal cyst bulging into the duodenum: ECD. 5. Jaundice and/or cholestasis due to stricture of the intrapancreatic CBD: 10F single or multiple plastic stent for calibration during 3 months. For relapsing cholestasis and stricture, 30F metal mesh stent versus surgical hepaticojejunostomy. The indications of endoscopic management for chronic pancreatitis are specific and require complete imaging and functional check up (ERCP, CT scanner, endosonography, pancreatic function tests). The technique is quite difficult and requires definition fluoroscopy, appropriate devices and experienced team. On this condition, the complication rate is very low and usually medically controlled. Treatment does not compromise any further surgery. Endoscopy allows to avoid or to postpone surgery which indication will become better defined and selected in the future.

Adult↗
PubMedDate not supplied

Preoperative endoscopic retrograde cholangiopancreatography: therapeutic impact in a general population of patients needing a cholecystectomy.

BACKGROUND/AIMS: The place of endoscopic retrograde cholangiopancreatography (ERCP) before open or laparoscopic cholecystectomy remains controversial. Most of the reports study highly selected series of patients and therefore do not give a survey of the actual situation in a general population. We describe here the therapeutic impact of preoperative ERCP in a continuous cohort of patients needing a cholecystectomy. MATERIAL AND METHODS: Data concerning a 2-year continuous and unselected series of 452 patients undergoing cholecystectomy were evaluated. RESULTS: Two hundred ninety-three patients (65%) presented with a chronic symptomatic biliary lithiasis and 159 patients (35%) with a complicated biliary lithiasis. A preoperative ERCP was performed in 206 patients, all presenting with a suspicion of associated lithiasis of the common bile duct (CBD). An endoscopic sphincterotomy was performed in 106 patients: 44 patients presented with CBD stones (9.7%), all successfully cleared by endoscopy. Laparoscopic cholecystectomy has been attempted in 367 patients (81%) and successfully performed in 333 patients (74%). Laparotomy as a first-choice procedure was performed in 85 patients (19%). Surgical choledochotomy was never performed. Postoperative ERCP was needed in 4 patients (0.88%) and in only 1 of them for a retained CBD stone (0.22%). CONCLUSIONS: In a continuous series of patients needing a cholecystectomy, preoperative ERCP was performed on the basis of suspected CBD disorders. It allows CBD stone detection and extraction in almost 10% of the patients and avoids peroperative CBD exploration, with a very low rate of retained stones after surgery. The association of preoperative ERCP with subsequent laparoscopic cholecystectomy (when feasible) offers the patient a quick recovery and a short hospital stay.

Adult↗
PubMedDate not supplied

Magnetic resonance cholangiopancreatography (MRCP): a perspective on potential clinical applications.

The recent development of MRCP allowed the recognition of the potential role of Magnetic Resonance (MR) in pancreatobiliary imaging. The increasing interest on MRCP relies on its non invasiveness (there is no need for contrast media administration) and on the projectional display of the biliary and pancreatic ducts in a way similar to endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTC). In addition, it offers the opportunity for dynamic analysis of biliopancreatic ducts which is useful in the assessment of subtle ductal alterations. The future of this attractive technique will depend on the demonstration of its diagnostic accuracy and on its availability. This article discusses the potential role of MRCP in the evaluation of biliary tract and pancreatic duct diseases.

Adult↗
PubMedDate not supplied

Treatment with terlipressin as a bridge to liver transplantation in a patient with hepatorenal syndrome.

Hepatorenal syndrome is a rapidly lethal complication of cirrhosis. The present case provides further evidence of the efficacy of terlipressin in this context even with concomitant treatment with propranolol. A 56 year old male with HBV related cirrhosis developed renal failure characteristic of hepatorenal syndrome. He was also taking propranolol for primary prophylaxis of variceal bleeding. Terlipressin 6 mg/day was administered during haemodialysis and after 1 week plasma creatinine dropped from 6.2 to 2.8 mg%. Daily urinary volume, plasma sodium and natriuresis dramatically increased during the treatment. Discontinuation of the treatment led to a rapid relapse of renal failure (plasma creatinine from 1.8 to 2.2 mg%) and the drug was readministered until a successful liver transplantation could be performed 1 month after the beginning of the treatment. The patient has now a near normal renal function 3 months after transplantation.

Antihypertensive Agents↗