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Biomedical subjects

M Gosselin

Publications and source records attributed to M Gosselin.

At least 73 records · Page 4Linked to original sources
PubMed1993

Usefulness of hepatic artery injection of iodized oil and 131I-labeled iodized oil before the therapeutic decision in hepatocellular carcinoma.

This study assesses the usefulness of intra-arterial injection of iodized oil (Lipiodol) as a tool for evaluating the therapeutic choice in a series of 72 consecutive patients with hepatocellular carcinoma (HCC). In 52 of these patients a scintigraphic study of the biodistribution of iodized oil was done, using 131I-iodized oil injection. A single tumor was detected in only 17 cases; 18 patients had a tumor involving only 1 lobe; in 7 cases CT scan disclosed a minute nodule in the opposite lobe of the main tumor. Eighteen patients had a portal thrombosis; in 12 of these cases CT scan showed iodized oil in the tumor emboli. The degree of intratumoral retention of iodized oil depended on the size of tumors and on the presence of arterioportal shunts. Our study demonstrates that only a few patients (4%) with HCC might benefit from curative surgery. The therapeutic benefit of methods using iodized oil injection might be estimated by means of its biodistribution variables (CT and/or scintigraphic data).

Adult↗
PubMed1993

[Cystic tumors and endocrine tumor of the pancreas. An unusual association].

Cystadenomas and cystadenocarcinomas are the most common cystic tumors of the pancreas. Their inner lining contains neuroendocrine cells that may, in rare cases, produce a systemic syndrome. Similarly, digestive or pancreatic endocrine tumors have been reported in association with cystic tumors of the pancreas. We report a case of cystadenocarcinoma of the pancreas head, associated with a serous cystadenoma and an endocrine tumor of the body of the pancreas. In a 70 year old patient, jaundiced due to obstruction of the extra-hepatic bile ducts, the abdominal ultrasound and CT scan showed a hypoechogenic hypodense lesion of the pancreas head resulting in an enlargement of the common bile duct and pancreatic duct. Echoendoscopy confirmed the diagnosis and gave additional information; it showed that the cephalic lesion was heterogeneous, with anechogene spaces separated by coarse echogenic septae associated to a solid contingent. Also detected by echoendoscopy was a cystic lesion containing thin septae and a contiguous hypoechogenic nodule of the body of the pancreas. Histology of the specimen following total pancreatectomy revealed a cephalic cystadenocarcinoma associated with a serous cystadenoma and a non-secreting endocrine tumor of the body region. This observation highlights the usefulness of echoendoscopy in the work-up of cystic lesions of the pancreas; indeed, the tumors of the body of the pancreas were not detected by others methods. Furthermore, there are reports in literature on endocrine secretion syndromes secondary to digestive endocrine tumors or neuroendocrine cells in the lining of cystic tumors of the pancreas.

Aged↗
PubMed1993

[Endoscopic treatment and extracorporeal lithotripsy in chronic calcifying pancreatitis. Preliminary results in 16 patients].

UNLABELLED: A new therapeutic approach has been recently proposed in the management of chronic pancreatitis, including pancreatic endoscopic papillotomy and extracorporeal shock wave lithotripsy. The aim of this study was to assess the feasibility and the short--and long-term results of these procedures in a series of 16 patients aged 48.9 +/- 14 years. The indication for endoscopic treatment was pain in 15 cases and steatorrhea in one case. Pancreatic duct abnormalities included main pancreatic duct stenosis with calculi (9 cases), communicating pseudocysts upstream to a ductal stenosis or obstruction by calculi (4 cases), and isolated calculi (4 cases). Clinical response and morphologic parameters were used for analysis. Mean follow-up was 18.6 months (3.5 months to 7 years). RESULTS: a) pancreatic endoscopic papillotomy, stents placement, and extracorporeal shock wave lithotripsy were successfully performed in 15 out of 16 cases, 1 out of 4 cases and 8 out of 8 cases, respectively; b) symptomatic improvement was observed in 11 of 15 patients with painful pancreatitis as relief was complete in 8, and partial in 3 cases. Pain relapse occurred in these latter 3 patients 4, 18 and 48 months after treatment; diabetes mellitus remained unchanged in all cases; c) diameter of the main pancreatic duct and pancreatic calcifications decreased in 8 of 15 cases and in 10 of 15 cases, respectively; pseudocyst disappeared in 2 of 4 cases; clinical improvement was significantly correlated with pancreatic morphology improvement. Clinical relapse was associated with calculi recurrence in every case. No complication was observed. Endoscopic papillotomy and extracorporeal shock wave lithotripsy are feasible in most cases of chronic pancreatitis. Relief of pain is obtained rapidly after treatment and seems to be correlated with the quality of pancreatic drainage.

Adult↗
PubMed1993

Relationship between gastric mucosal changes and hemodynamic patterns in alcoholic cirrhosis. A prospective study.

Most gastric mucosal changes in cirrhosis are thought to be related to vasculopathy. The aim of this study was to determine whether there was a relationship between gastric mucosal changes and hemodynamic in cirrhosis. Thirty patients with alcoholic cirrhosis were divided into four groups: no congestive gastropathy (n = 6), mild congestive gastropathy type 1 (discrete mosaic pattern) (n = 9), mild congestive gastropathy type 2 (obvious mosaic pattern) (n = 9), and severe congestive gastropathy (n = 6). The four groups did not significantly differ with respect to clinical and biochemical data, degree of hepatic dysfunction, or endoscopic signs of portal hypertension. A hyperdynamic circulatory syndrome was observed in most patients, but tended to be more pronounced in patients with severe congestive gastropathy and mild congestive gastropathy type 2 as compared to patients with normal mucosa, or mild congestive gastropathy type 1. Systemic vascular resistance was found to be significantly lower in high-grade patients (mild congestive gastropathy type 2 + severe congestive gastropathy, n = 15) as compared with low-grade patients (no congestive gastropathy + mild congestive gastropathy type 1, n = 15) (736 +/- 267 vs 1,046 +/- 403 dyne.s.cm-5, P = 0.02). Neither splanchnic hemodynamics as assessed by the degree of portal hypertension (hepatic venous pressure gradient) and superior mesenteric artery vascular resistance (Doppler measurement of the pulsatility index) catecholamines or glucagon serum levels differed significantly between the four groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Does manometric megarectum have a symptomatic role in patients complaining of dyschezia?].

UNLABELLED: Adults with dyschezia are occasionally diagnosed as having megarectum when anorectal manometry identifies rectal sensory disturbances. It remains difficult however to ascertain whether this state represents a part of the pathophysiological process responsible for symptoms, or just an associated phenomenon. The aim of this study was to highlight the symptomatic and functional features encountered in patients with dyschezia and megarectum, and to compare them with those obtained in an asymptomatic group and in a group of patients complaining of dyschezia without manometric megarectum. PATIENTS AND METHODS: The maximum tolerable volume (MTV) was defined as the highest tolerable volume which induced painful and irrepressible repletion upon inflation of the rectum with air. The upper normal range of MTV (330 mL) was obtained from rectal manometry performed in a group of 18 healthy volunteers and asymptomatic patients (mean age: 37.8 +/- 14 years, 12 F, 6 M). Between February 90 and February 92, 27 consecutive adults (48 ans +/- 15 years, 26 F, 1 M) suffering from dyschezia were found to have abnormally increased MTV, and were compared to a group of 35 patients (47 +/- 15.3 years, 34 F, 1 M) with dyschezia with MTV within normal ranges. Symptomatic patients underwent detailed interrogation, clinical examination, anorectal manometry, and evacuation proctography. RESULTS: Parity, prevalence of hysterectomy, symptoms and natural history did not differ between the two groups except for increased use of antidepressive agents in the megarectum group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Black esophagus. Three new cases].

We report three cases of "black esophagus" defined as a diffuse or patchy black color of the esophagus on endoscopy, associated with mucosa necrosis at histologic examination. Ischemia was invocated in two cases and alcaline reflux seemed to be likely in the third case. These observations are compared with the seven others cases previously reported in the literature.

Aged↗
PubMed1992

Chemoembolization of hepatocellular carcinomas. A study of the biodistribution and pharmacokinetics of doxorubicin.

BACKGROUND: This study evaluated the effects of an association of ethiodized oil (Lipiodol Ultra Fluide, Laboratoires Guerbet, Aulnay-sous-Bois, France), with or without gelatin sponge, with doxorubicin (Adriamycin, Adria Laboratories, Columbus, OH) on the biodistribution and kinetics of doxorubicin during intraarterial injection. METHODS: Eighteen patients with hepatocellular carcinoma on cirrhotic liver received a therapeutic injection into the hepatic artery of 50 mg of doxorubicin alone (Group 1; n = 4), or emulsified in 10 ml of ethiodized oil and 2.5 ml of ioxaglate (Hexabrix, Laboratoires Guerbet) with (Group 2; n = 7) or without (Group 3; n = 7) gelatin sponge embolization. Before treatment, the absence of intrahepatic shunts was verified by an injection of technetium-labeled albumin macroaggregates. The biodistribution of doxorubicin was studied on two fronts: (1) pharmacokinetic--by measurement of the doxorubicin blood level during the 48 hours after injection; and (2) scintigraphic (2 mg of doxorubicin were labeled with 2 mCi of iodine 131)--by examination of the scintigrams and calculation of the following parameters: tumours liver/nontumorous liver binding ratio (T/NT ratio), liver/liver+lungs+abdomen binding ratio, and doxorubicin half-life in tumorous tissue. RESULTS: Pharmacokinetics results showed the following: the peak plasma concentration was significantly higher in Group 1 as compared with Groups 2 or 3 (Group 1: 2.1 +/- 0.9 mg/ml; Group 2: 0.9 +/- 0.3 mg/ml; Group 3: 0.5 +/- 0.2 mg/ml); the area under curve calculated from time zero to 1 hour was lower in Groups 2 and 3 compared with Group 1. Examination of the scintigrams showed the following: diffuse activity throughout the organism (Group 1), diffuse activity with strong hepatic and tumorous binding (Group 2), and mostly hepatic and tumoral binding (Group 3). The liver/liver+lungs+abdomen binding ratio was 28% +/- 1% in Group 1, 36% +/- 5% in Group 2, and 63% +/- 7% in Group 3. The T/NT ratios were 1.0 +/- 0 (Group 1), 1.5 +/- 0.1 (Group 2), and 4.7 +/- 0.5 (Group 3). The doxorubicin half-lives in tumourous tissue were 0.7 +/- 0.1 days (Group 1), 1.8 +/- 0.2 days (Group 2), and 2.6 days (n = 1; Group 3). CONCLUSIONS: This study shows (1) that the association of ethiodized oil with doxorubicin lowers the peak concentration of doxorubicin and increases the intratumoral concentration and half-life of doxorubicin, and (2) that these kinetic ameliorations are even more pronounced after embolization. Therefore, from a kinetic standpoint, the doxorubicin-ethiodized oil-gelatin sponge association is the best.

Aged↗
PubMed1992

Defecatory disorders, anorectal and pelvic floor dysfunction: a polygamy? Radiologic and manometric studies in 41 patients.

A consecutive series of 41 patients with defecatory disorders was prospectively studied by anal manometry and evacuation proctography to determine the relationship between abnormalities and symptoms. The patients (29 female, 12 male, aged 41 +/- 2.3 years) all complained of difficulty in evacuation. All had normal colonoscopy and biochemistry. There was no evidence of megacolon or megarectum, and no symptoms had been previously treated by pelvic floor surgery. All subjects completed detailed questionnaires related to gastrointestinal symptoms with special reference to excessive straining and discomfort, digital manipulations during defecation, a sense of pelvic heaviness and incomplete evacuation. Each patient underwent clinical examination, anal manometry and defecography during a single outpatient visit. Rectocele (16 patients) was significantly associated with vaginal digitation, lower stool frequency, delayed rectal emptying and decreased rectal sensation to distension. Increased anal pressure on straining (14 patients) was also related to a poor rectal emptying in 13 patients. Neither perineal descent (24 patients) nor external rectal prolapse (12 patients) was related to objective obstruction. Nevertheless there was an association with pelvic heaviness and lower anal manometric recordings. Five among 16 patients with rectocele had manometric anismus. Forty percent of patients with intussusception also had a paradoxical sphincter response during defaecation. Furthermore, associated abnormalities were extremely common (34 of 41 patients), accurate interpretation of which was necessary for planning effective therapy.

Adult↗
PubMed1992

Helicobacter pylori: a risk and severity factor of non-steroidal anti-inflammatory drug induced gastropathy.

This prospective study aimed to determine the prevalence of Helicobacter pylori infection in relation to the occurrence and severity of NSAIDs induced gastropathy. A total of 111 patients were studied-66 were taking NSAIDs and 45 were control patients. All patients underwent endoscopy during which antral biopsy specimens were taken to determine H pylori status (Gram and Giemsa staining, urease test, and cultures). The NSAID group comprised: group I, patients without mucosal damage (n = 28); group II, patients with gastropathy (n = 26); and group III, patients with bleeding associated with NSAID induced gastropathy (n = 12). Control patients had neither dyspeptic symptoms nor endoscopic lesions. There were no differences in age, sex ratio, or presence of H pylori (26% v 24%) between the NSAID and the control groups. Among patients taking NSAIDs, H pylori infection was more frequently (p < 0.02) diagnosed in those who presented with gastropathy (groups II and III: 37%) than in those without lesions (group I: 11%). The frequency of H pylori infection increased significantly with the severity of gastropathy (group I = 11%; group II = 31%; group III = 50%; p < 0.03). H pylori infection was associated with chronic active gastritis (group I = 21%; group II = 35%; group III = 67%; p < 0.05). These data suggest that H pylori may be a risk factor of NSAID induced gastropathy.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1992

[Villous tumors of the Wirsung's duct and pancreatic intraductal adenocarcinoma: interrelation or accidental association?].

Villous neoplasms of the main pancreatic duct are uncommon. Two cases of neoplasm of the main cephalic pancreatic duct in 61- and 42-year-old patients presenting with long standing (10 and 12 years) history of abdominal pain are reported. In both cases, duodenal fistula was present and mucus was observed by endoscopy at the fistula and major papilla levels. Endoscopic retrograde pancreatography showed a stricture of the main pancreatic duct in the pancreatic head. In one case, with incomplete stricture, pancreatic ducts disclosed typical features of chronic obstructive pancreatitis and contained mucus casts. Histologic examination of total and proximal duodenopancreatectomy showed a villous neoplastic pattern with focal malignant changes within the main pancreatic duct. The adjacent pancreatic tissue showed signs of stromal invasion without lymph node or nervous infiltration. Glandular parenchyma was atrophic in the pancreatic body and tail, with extensive fibrosis, and the pancreatic duct depicted signs of nonpapillary hyperplasia. Histochemical study disclosed a predominant sialomucin secretion by villous adenoma and sulfomucin secretion by epithelial cells lining the accessory or main caudal pancreatic ducts. These results lead us to suggest a possible relationship between villous adenoma of ducts and pancreatic adenocarcinoma.

Adenocarcinoma↗
PubMed1992

[Results of portacaval shunt after failure of sclerotherapy in patients with cirrhosis].

Therapy of variceal bleeding is currently based on endoscopic sclerotherapy. However, the treatment of bleeding recurrences after sclerotherapy has not yet been established, but consists of the choice between continuation of sclerotherapy or a surgical procedure. We report herein the results of portocaval shunt performed in 26 cirrhotic patients among the 175 cirrhotic patients (15%) admitted between 1985 and 1990 to our Intensive Care Unit for variceal bleeding. These 26 patients were operated because of failure of sclerotherapy as defined by haemostasis failure (n = 1), the persistence of unchanged oesophageal varices after six sessions of sclerotherapy (n = 1), and the occurrence of at least one severe episode of rebleeding (n = 24). Emergency and elective portocaval shunts were performed in 12 and 14 cases respectively. The time delay between admission and surgical procedure was equal to 21 +/- 8 hours and 12 +/- 4 days in the two groups respectively. The operative mortality (30 days) was equal to 23% and was observed in emergency shunts only. Actuarial survival rates were significantly different between the two groups (p < 0.01). Predictive factors of mortality as assessed by univariate analysis were the emergency nature of the procedure, serum aminotransferases and urea levels at the time of the index bleeding, and the number of bleeding episodes related to portal hypertension before the index bleeding. The prognosis at one year was not influenced by the number of bleeding recurrences between the index bleeding and the bleeding episode justifying the shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

Unusual presentation of a case of brain abscess after endoscopic injection sclerotherapy of esophageal varices.

Although an increasing number and variety of complications of endoscopic injection sclerotherapy (EIS) of bleeding esophageal varices have been reported, infectious complications are rare. A case of brain abscess following EIS is reported which was characterised by an unusual clinical presentation in that there was no fever or leucocytosis. This presentation could have led to the abscesses being mistaken for brain metastases. The outcome of antimicrobial therapy was favorable which provided further evidence in support of the diagnosis.

Anti-Bacterial Agents↗
PubMed1991

[Contribution of 131I MIBG scintigraphy in the diagnosis of carcinoid tumors of the digestive tract. Experience of 14 cases].

131I MIBG scintigraphy is of great value in the diagnosis and the treatment of several tumors derived from the neural crest. But, its role in the assessment of carcinoid tumors remains to be evaluated. It was the aim of this prospective study. Between 1987 and 1989, 14 consecutive patients with carcinoid tumors were studied. Planar scintigrams were obtained 24 and 48 hours after the intravenous injection of 74 MBq of 131I MIBG. At least one scintigraphy was performed in every patient; at that time one or several abdominal tumor sites (a total of 22 sites) were found and histologically proven. Scintigram was judged as positive in 9 of 14 patients (64 p. 100); 68 percent of the 22 tumor sites and 86 percent of the 14 extra-hepatic tumor sites took up 131I MIBG. Liver metastases were overlooked on scintigrams in 5 of 8 patients. Scintigraphy was the only positive examination in 3 patients. No false positive scintigrams were noticed. These results emphasize the value of 131I MIBG scintigraphy in the assessment of carcinoid value tumors.

3-Iodobenzylguanidine↗