Biliary tract reconstruction after injury of the main hepatic duct.
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Hepatic Duct, Common↗
Biomedical subjects
M Huguier
Publications and source records attributed to M Huguier.
Treatment of adenocarcinoma of the pancreas with somatostatin and gonadoliberin (luteinizing hormone-releasing hormone). The French Associations for Surgical Research.
Experimental studies have shown a significant inhibition of adenocarcinoma of the pancreas by gonadoliberin (luteinizing hormone-releasing hormone [LH-RH]) and somatostatin. The aim of this prospective randomized study was to compare the potential value of somatostatin (250 micrograms every 8 hours), LH-RH (3.75 mg monthly), or combined, to a control group. One hundred sixty-three patients with adenocarcinoma of the pancreas who did not undergo resection for cure were divided into 4 groups that did not differ in terms of clinical, biologic, or pathologic data. The mean survival times were 6 months in the LH-RH plus somatostatin group, 5.5 months in the LH-RH group, 4.3 months in the control group, and 3.8 months in the somatostatin group. However, the life-table analyses for all randomized patients, and separately according to sex, the lymph node extension, and metastatic spread were not different between groups. Improvement of patient status was observed in 20% of the patients receiving hormone therapy without any difference noted between the treatment regimens. These disappointing results may be explained by the degree of extension of pancreatic carcinoma in the patients studied. The results suggest that different hormone therapy regimens might be considered according to the age and the sex of patients, as well as to the presence or absence of hormone receptors.
Adenocarcinoma↗
Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial.
PURPOSE: A multicentric randomized study that compared patients who received intrahepatic arterial infusion (HAI) to a group of patients who did not receive HAI (control group) was performed for unresectable hepatic metastases from primary colorectal carcinoma. PATIENTS AND METHODS: One hundred sixty-six patients were assigned randomly to HAI of floxuridine (5 fluoro-2'deoxyuridine [FUDR]) 0.3 mg/kg/d for 14 days every 4 weeks or to the control group; this latter group, depending on the investigator's choice, was either under observation or received systemic fluorouracil (5-FU). The same regimen of systemic 5-FU also was administered to the HAI group in the event of extrahepatic progression. No crossover from the control group to the HAI group was permitted. The mean duration of follow-up was 54 months (range, 31 to 72), and 163 patients were analyzed. RESULTS: A significant improvement was observed in the survival rate for the 81 patients assigned to HAI group (P less than .02) with a 1-year survival rate of 64% versus 44% in the control group (82 patients). The 2-year survival rate was 23% versus 13%. The median survival was 15 months versus 11 months for the HAI group and the control group, respectively. Survival was better for patients with a less than 30% liver involvement, and for those treated in more specialized centers. The hepatotoxic effects of HAI were observed in 47 patients (chemical hepatitis [n = 28], and biliary sclerosis [n = 19]). The 1-year rate of sclerosing cholangitis was equal to 25%. Gastrointestinal toxicity was infrequent and consisted of gastritis or diarrhea. CONCLUSIONS: Therapy with HAI of FUDR improves the survival of patients with liver metastases over colorectal carcinoma. However, the methods that are used to diminish the toxicity of HAI and efficient systemic chemotherapy, such as a combination of 5-FU and leucovorin, are required to prevent extrahepatic metastases.
Colorectal Neoplasms↗
[Experimental sclerosing cholangitis following intrabiliary injection of formol in the rat].
Our study was aimed at assessing the effect on the biliary epithelium of formol and hypertonic salt serum solutions used as parasiticide for hydatid cysts of the liver in rats. One hundred and forty six rats were administrated an intrabiliary injection of isotonic salt serum (control group), of 20% hypertonic salt serum and of 0.5% and 2% formol solutions. A histological study performed 3 months later did not show any abnormality in the rat control group (n = 11). In the hypertonic salt serum group (n = 14) and 0.5% formol group (n = 12), moderate lesions of biliary epithelium were observed. After a 2% formol injection, a periductal sclerosis was observed in 11 cases out of 16, associated with pseudocirrhosis lesions in 4 cases. A sequential histo-immunochemical study did not show any histological abnormalities in the rat control group (n = 24). In rats which were administrated a 2% formol solution (n = 36), first abnormalities were observed as soon as the 7th day with a IA antigen expression at the biliary epithelium level. Fibrosis lesions were observed after 2 months. After 9 months, the infiltration included only T lymphocytes in direct contact with biliary tracts. A cholangiographic study showed a normal aspect in the rat control group (n = 11) or in rats having received hypertonic salt serum (n = 11), and stenoses of biliary tracts, mainly intrahepatic, in 10 rats out of the 11 of the 2% formol group.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Is the follow-up of patients operated on for gastric carcinoma of benefit to the patient?
In patients operated on for gastric carcinoma, the main purpose of a follow-up program is to diagnose recurrent disease and initiate treatment at an early stage. One hundred and ninety-seven consecutive patients were studied, 43 of whom had not received a resection (27%). Resections were carried out in 144 patients, in either palliative (N = 20), or curative (N = 122) intent. The follow-up program included visits to the outpatient clinic at one month, six months, one year, and every year during the five post-operative years. Shorter intervals were employed as indicated by the functional or general status of the patients. One patient has been lost to follow-up. In palliative surgery, median survival was 3 months in patients undergoing laparotomy, 6 months following palliative surgery without resection, and 8 months following palliative resection. In patients who underwent curative resection, 65 are still alive without recurrent disease (57%). Thirty-six of them have been followed-up for more than 5 years. Seven patients died without recurrence. Of 42 patients with recurrence, 10 underwent a reoperation. The only resection was performed for liver metastasis. This patient died 14 months later. Survival in the 9 other patients did not exceed 6 months. This experience suggests that a follow-up program of patients operated on for gastric carcinoma is disappointing.
Adenocarcinoma↗
[Peroperative cholangiography in cholelithiasis. Results of a multivariate analysis].
This study was done to select patients with a low risk of common bile duct (CBD) stones in whom operative cholangiography could be avoided. Operative cholangiography was performed upon 511 patients. Two different groups of patients were identified: patients with CBD stones visualized by CBD exploration (n = 90) and patients with no CBD stones at the time of operative cholangiography (n = 42). Multivariate analysis (stepwise logistic regression) showed that five variables were correlated with the presence of CBD stones: size of CBD equal to or greater than 12 millimeters, gallstones equal to or less than 10 millimeters, advanced age, chronic or acute cholecystitis and pas history of biliary colic. Using a scoring system, a group of patients with a low risk (less than 2%) of CBD stones could be easily determined. In this group of patients, operative cholangiography may be avoided.
Adult↗
[Medical behaviors and cancer of the exocrine pancreas].
A French national enquiry examined 4,530 cases of cancer of the exocrine pancreas treated from 1982 to 1989. Ultrasonography was performed in 98% of cases. Other radiological or biological investigations varied from one department to another (P < 0.001). Of 769 patients seen in Gastroenterology departments, 47% (range: 0 to 72%) were operated on. Of 3,761 patients undergoing operation, surgical techniques differed significantly from one department to another (P < 0.001). Resections were performed in 21% (range: 2 to 45%) of cases. Causes of unresectability, choice of biliary bypass, indications for gastrojejunostomy, and use of splanchnicectomy varied from one surgical department to another (P < 0.01). Wide variance in therapeutic policies may be explained by differences in local indications or surgical expertise, giving support to the need for a consensus conference to discern the indications of the available therapeutic alternatives for cancer of the exocrine pancreas.
Biliopancreatic Diversion↗
[Medical mission in Japan].
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Academic Medical Centers↗
Stomach cancer after partial gastrectomy for benign ulcer disease. A critical analysis of epidemiological reports.
The controversy about the risk of cancer in patients surgically treated for peptic ulcer is debated in the literature. We analyzed published epidemiological studies, in an attempt to answer the following questions: 1) is there an increased risk of cancer in patients who underwent partial gastrectomy for ulcer disease?; 2) is such a risk influenced by the type of operation performed and by the original pathological lesion?; 3) are there any recommendations for peptic ulcer surgery and for a specific follow-up schedule of the patients? Twelve "prospective" studies have been published on patients operated on for peptic ulcer. These studies are based on the follow-up of a cohort over a certain period of time. Results are expressed and analyzed using the incidence ratio observed in the cohort, comparing observed with expected cases in a similar general population. The results of seven of these studies favor the hypothesis of an increased risk of stomach cancer in patients operated on for peptic ulcer disease, while those of five do not support this hypothesis. The results of two of these studies were obtained by multivariate analyses, which represent the best statistical methodology known for assessing the respective role of confounding variables. We therefore believe that the evidence is good enough to identify patients who underwent partial gastrectomy more than 20 years previously as a high-risk group for the development of carcinoma. We therefore recommend that these patients should be offered regular endoscopy, especially if they underwent a Billroth II surgical procedure.(ABSTRACT TRUNCATED AT 250 WORDS)
Age Factors↗
[Pancreatic epithelial tumors with double cellular components. Report of two cases with immunohistochemical study].
Histopathological studies of pancreatic tumors can show two different cellular components: exocrine and endocrine. Histological and immunohistochemical staining is used to confirm the diagnosis and to appreciate the probable presence of an endocrine secretion. The hypothetical common embryological origin of the different pancreatic components is strengthened by the coexistence of these two cellular types; experimental studies in animals seem to confirm this view.
Aged↗
[Perforated peptic ulcer. Immediate results of therapeutic strategy].
The aim of this study was to evaluate of logical program for the management of patients with perforated peptic ulcers. The case records of 75 consecutive patients were reviewed. The average age of the patients was 52 years. Ten patients were older than 80. The logical program was based on preoperative risk factors (concurrent medical illness, preoperative shock, and longstanding perforation more than 48 hours), history of chronic ulcer symptoms, and in selected cases, spontaneous seal on X-Ray gastroduodenogram with a water soluble contrast medium. The program was applied in 75% of cases and not applied in 25%. Out of 9 post-operative deaths (12%), 3 had a surgical cause: leakage of the suture with dehiscence in two cases. The mortality increased progressively with increasing of number of risk factors: 0%, 10% and 55% in patients with no, one, and two or three risk factors respectively. These findings constitute a validation of the predictive factors of death proposed by Boey et al. A logical program for the management of patients based on results of such multifactorial studies on risk factors, and on results of randomized prospective controlled studies may be applied in almost all patients. Our results also suggest that the quality of the perforation suture, and of the abdominal closure, especially in old and obese patients, are the most important factors to decrease the mortality.
Adult↗
[Cholecystectomy: the cost of surgery].
290 patients who underwent cholecystectomy with operative cholangiography were included in the study. Operating time and material cost of each operation were prospectively measured for each patient. The mean operating time was 107 min, and the median time was 100 min. Differences in operating time between surgeons were statistically significant. The shortest mean operating time was 68 min, and the longest was 136 min. The mean cost of material used was 158 francs. The lowest mean cost was 113 francs, and the highest was 174 francs. Such measures of operating time and costs for usual and standardized operations are possible. They should be used to establish a more objective fee system for operations inside a surgical specialty, and between different specialties.
Cholecystectomy↗
Selective contraindications based on multivariate analysis for operative cholangiography in biliary lithiasis.
This study was done to select patients with a low risk of common bile duct (CBD) stones in whom operative cholangiography could be avoided. Operative cholangiography was performed upon 511 patients. Two different groups of patients were identified--patients with CBD stones visualized by CBD exploration (n = 90) and patients with no CBD stones at the time of operative cholangiography (n = 421). Multivariate analysis (stepwise logistic regression) showed that five variables were correlated with the presence of CBD stones--size of CBD equal to or greater than 12 millimeters, gallstones equal to or less than 10 millimeters, advanced age, chronic or acute cholecystitis and past history of biliary colic. Using a scoring system, a group of patients with a low risk (less than 2 percent) of CBD stones could be easily determined. In this group of patients, operative cholangiography may be avoided.
Adult↗
[Treatment of exocrine pancreas tumors].
A review of the literature over the last five years reveals that the results of treatment of pancreatic carcinoma have barely improved over the last thirty years, except in terms of the operative mortality which has markedly improved over the last decade. Pancreatectomy still constitutes the only, although slight, chance of cure. It must be reserved to the rare macroscopically curable cases, i.e. small tumours of the head of the pancreas, apparently confined to the pancreas. Palliative treatments should preferably be surgical. Endoscopic biliary drainage should only be performed in inoperable cases. Adjuvant radiotherapy and chemotherapy must be integrated into curative and palliative strategies. These various therapeutic modalities can only be evaluated by means of prospective studies and controlled trials.
Antineoplastic Combined Chemotherapy Protocols↗
[Coloanal and ileoanal anastomosis. A modified technic using the Premium CEEA stapler].
A modified stapling technique for perianal coloanal or ileoanal anastomosis is described. The rectum is everted and transected at dentate line level under direct vision. Anastomosis is performed transanally and through the staple line suture of the anal stump, using the Premium CEEA stapler. We used this technique on five occasions without complications. It makes it easier to perform coloanal or ileoanal anastomosis and provides a better control of carcinomas than the other techniques.
Anal Canal↗
Sclerosing cholangitis induced by formaldehyde solution injected into the biliary tree of rats.
Sclerosing cholangitis has been reported after surgical treatment of hydatid disease of the liver and has been hypothetically attributed to the caustic effect of the parasiticide solution injected into the cyst and diffusing into the biliary tree through a cystic-biliary fistula. In this experimental study, we showed that, in rats, injection into the biliary tract of 20% hypertonic saline solution or 2% formaldehyde solution, the most commonly used scolicidal solutions, was followed by lesions of the biliary epithelium. As compared with 20% hypertonic saline solution, the 2% formaldehyde solution caused more severe lesions of the biliary epithelium and, in addition, induced the development of sclerosis. This experimental study confirms the deleterious effect of scolicidal solutions to the biliary epithelium, shows that their effect is mainly related to the causticity of the scolicidal solution, and indicates that intracystic injection of 2% formaldehyde solution should be abandoned.
Animals↗
Adenocarcinoma of the rectum treated by abdominoperineal excision: multivariate analysis of prognostic factors.
The aims of this study were to describe the results of 100 consecutive abdominoperineal excisions, and to try to define homogeneous subgroups of survivors using the Cox regression analysis model. There was one postoperative death. No patient was lost to follow-up. Overall 5-year survival rate was 45%. Multivariate analysis selected 3 prognostic factors: lymph node involvement (p less than 0.001), local tumour extent (P = 0.08), and extension to adjacent organs (p = 0.03). Four subgroups of patients were defined. Best survival was observed in patients (n = 43) with tumour invading into the subserosa (W1) or less and without lymph node metastasis (N0), with a 5-year survival of 82% (group 1). Patients in Group 2 (n = 18) had a tumour invading into the muscularis propria or less with lymph node metastasis (W0 N+), or into the serosa or perirectal fat without lymph node invasion (W2 N0), with a 5-year survival of 51%. Patients in Group 3 (n = 17) had a tumour invading into the subserosa with lymph node invasion (W1 N+) or extension to adjacent organ without lymph node invasion (W3 N0) with a 5-year survival of 24%. Patients in group 4 (n = 22) had extension into the serosa or perirectal fat or more with lymph node invasion (W2 N+) with a 5-year survival of 2%. This scoring system is simple, practical and easy to apply. If it can be confirmed by other studies, its routine adoption could be justified.
Adenocarcinoma↗
[Hormonotherapy of cancer of the exocrine pancreas].
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Female↗