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M Julien

Publications and source records attributed to M Julien.

At least 55 records · Page 3Linked to original sources
PubMed1994

[Liver transplantation with preservation of portacaval flow: comparison with the conventional technique].

A modified technique of liver transplantation was used in 46 adults. This technique consisted of: a) construction of a temporary end-to-side porto-caval shunt, b) total hepatectomy with preservation of the inferior vena cava, c) closure of the graft inferior vena cava at both ends, d) partial clamping of the recipient's inferior vena cava followed by side-to-side cavocaval anastomosis, e) suppression of the temporary porto-caval shunt with completion of the operation according to the conventional technique. The results obtained with this technique were compared to those of 40 transplantations performed with the conventional technique. The use of veno-venous extracorporeal circulation was able to be avoided in every case with the modified technique, but was necessary in 70% of cases with the conventional technique. A significant reduction of the operating time (7.2 vs 9.3 hours) and transfusional requirements (11.4 vs 20.3 units of packed cells) was observed. The principal characteristic of this technique was the haemodynamic stability of the patients throughout the operation. These results suggest that this technique is an reliable and effective alternative to the use of veno-venous extracorporeal circulation during liver transplantation in adults.

Extracorporeal Circulation↗
PubMed1994

[Value of a powerful initial immunosuppression after liver transplantation. Prospective study of 60 cases].

With usual immunosuppression, the incidence of acute rejection after liver transplantation is higher than 60% in most series. The aim of this prospective study was to assess the value of a powerful initial immunosuppression on acute rejection, mortality and morbidity. REGIMEN. Group 1: patients with normal postoperative renal function (serum creatinaemia < 150 mumol/L) received cyclosporine from day 1 to day 15 by continuous i.v. infusion to reach a whole blood level of 400 to 500 ng/mL; after day 15, cyclosporine was reduced. Group 2: in cases of postoperative renal failure (serum creatinine > or = 150 mumol/L), anti-thymocyte globulins were used for 10 days; cyclosporine was introduced after recovery of renal failure at usual doses. In addition, all patients received steroids and azathioprine according to usual regimens. RESULTS. From January 1989 to June 1992, 60 cases were studied in 59 patients: 45 (75%) entered group 1 and 15 (25%) entered group 2. In group 1, there were 11 acute rejection episodes (24%) and one postoperative death at three months (2.3%). In group 2, two early deaths (within 5 days) were excluded from the study of rejection. Among the 13 remaining cases, there were three episodes of acute rejection (23%) and one hospital death at three months. Overall, there were 14 episodes of acute rejection (24%), 12 of which were steroid-responsive (86%), no chronic rejection, a usual rate of infections (57%), one retransplantation (1.7%) and a hospital mortality of 6.8% (4 of 59 cases). One year survival was 78%, with 5 of 7 late deaths due to recurrent cancer. CONCLUSIONS. Our results suggest that, after liver transplantation, a) high initial cyclosporine dose in patients with normal postoperative renal function is associated with reduced incidence and severity of acute rejection without increased mortality and morbidity, b) antithymocyte globulins are an efficient alternative to cyclosporine in patients with postoperative acute renal failure and saves OKT3 for the treatment of steroid-resistant rejection.

Adult↗
PubMed1994

[Myofibroblastoma of the breast. Report of 8 cases].

Eight cases of breast myofibroblastomas are reported: two in men and six in post-menopausal women. This study and a review of the 19 published cases permit to define more precisely the particular features of this rare and benign mesenchymal tumour. Good demarcation, lack of necrosis and nuclear atypia argue for the benign nature of the lesion. It is made up of spindle cells (mainles myofibroblasts) which are positive for vimentin and not for S 100 protein or epithelial markers. Alpha-smooth muscle cell actin and desmin labelling are heterogeneous. This immunohistochemical study underlines the variable results of myofibroblasts for smooth muscle markers reflecting different degrees in their differentiation, without resolving the question of their origin. A simple surgical excision is required for this benign lesion. No recurrence has never been observed.

Aged↗
PubMed1993

Differences in the transbilayer and lateral motions of fluorescent analogs of phosphatidylcholine and phosphatidylethanolamine in the apical plasma membrane of bovine aortic endothelial cells.

In the plasma membrane of various eucaryotic cell types, in particular blood platelets and erythrocytes, it is known that phospholipids are asymmetrically distributed between the two leaflets of the lipid bilayer and that this transverse asymmetry is controlled by an aminophospholipid translocase activity. In this respect, it was of interest to check whether there are differential transbilayer movements between amino- and neutral phospholipids in the apical plasma membrane of vascular endothelial cells which form the inner nonthrombogenic lining of the large blood vessel. In the first step we compared the transbilayer localization and also the rate of lateral motion of two fluorescent analogs of phosphatidylcholine and phosphatidylethanolamine, namely C6-NBD-PC and C6-NBD-PE, inserted into the apical plasma membrane of bovine aortic endothelial cells, in vitro. By the use of back-exchange experiments we have found that C6-NBD-PC could be removed from the cell membrane toward the culture medium regardless of the incubation conditions used, i.e., just after cell labeling at 0 degrees C or even after further cell incubation for 1 h at 0 or 20 degrees C. In contrast, C6-NBD-PE could be removed only when the cells were maintained at 0 degrees C. After incubation for 1 h at 20 degrees C, 85% of the probe molecules remained nonexchangeable, indicating probe translocation from the outer to the inner leaflet of the lipid bilayer. This "flip" process, which occurred at 20 degrees C, was abolished when the endothelial cells were preincubated with N-ethylmaleimide, diamide, vanadate (VO4(3-)) and vanadyl (VO2+) ions, a set of substances which inhibit aminophospholipid translocase activity in various systems, and with a combination of sodium azide and 2-deoxyglucose which led to nearly complete ATP depletion in the cells. Fluorescence recovery after photobleaching experiments were also carried out to specify more precisely the localization and dynamics of the probes in the two leaflets of the plasma membrane lipid bilayer. They produced lateral diffusion coefficients D of 1.2 +/- 0.05 x 10(-9) cm2/s for C6-NBD-PC and 2.8 +/- 0.3 x 10(-9) cm2/s for C6-NBD-PE, when the two probes were located in the outer leaflet of the plasma membrane, just after cell labeling at 0 degree C.(ABSTRACT TRUNCATED AT 400 WORDS)

Adenosine Triphosphate↗
PubMed1993

Effect of phenytoin on acute lung injuries in unanesthetized sheep.

OBJECTIVE: To determine if the intravenous administration of phenytoin attenuates or prevents acute experimental lung injury. DESIGN: Placebo-controlled, longitudinal animal investigative study. SETTING: University research laboratory. SUBJECTS: Sixteen yearling female lambs weighing 30 +/- 3 kg. INTERVENTION: After administration of anesthesia, the animals were endotracheally intubated and mechanically ventilated. Using sterile techniques, four thoracotomies were performed. Through the left fourth intercostal space, cannulas for pressure measurements were inserted directly into the main pulmonary artery and left atrium. An ultrasound flow cuff for determination of cardiac output was placed around the main pulmonary artery. Through the left tenth intercostal space, the diaphragmatic and mediastinal parietal pleura were widely cauterized. Through the right tenth intercostal space, the caudal mediastinal lymph node was identified and divided at the caudal margin of the right pulmonary ligament, and a 1- to 2-cm portion of the node distal to the ligament was resected. The diaphragmatic and mediastinal parietal pleura were widely cauterized. Through the right sixth intercostal space, the efferent duct (or ducts) was identified, ligated at the site of entry into the thoracic duct, and cannulated. The lymph cannula was brought to the outside of the thorax through a separate stab wound. MEASUREMENTS AND MAIN RESULTS: Unanesthetized sheep were studied 7 to 10 days after surgery. Hemodynamic, lung fluid balance, and arterial blood variables were measured in uninjured sheep and in sheep injured by intravenous infusions of Escherichia coli endotoxin (1 microgram/kg iv over 30 mins), air bubbles (0.056 to 0.074 mL/kg/min over 4 hrs), or oleic acid (0.06 mL/kg over 1 hr). The sheep were studied when untreated and after pretreatment with phenytoin. We found that the expected increase in protein-rich lung lymph flow with injuries, resulting from increased microvascular permeability in the lungs, was attenuated by phenytoin when the lungs were injured by endotoxin or air bubbles. In contrast, phenytoin had no effect on oleic acid-induced lung injury or on uninjured lungs. CONCLUSIONS: Phenytoin attenuates acute lung injuries in sheep that are thought to be caused by stimulation of host inflammatory responses (e.g., endotoxin and air bubbles), but has no effect on direct injuries to the lungs (e.g., oleic acid). A plausible mechanism for this finding is phenytoin inhibition of polymorphonuclear leukocyte function.

Animals↗
PubMed1992

[Liver transplantation associated with combined adjuvant treatment in hepatocellular carcinoma. Feasibility and preliminary results].

Combined adjuvant therapy was prospectively assessed in 7 patients receiving orthotopic liver transplantation for hepatocellular carcinoma complicating cirrhosis. The protocol included hepatic arterial chemotherapy while waiting for transplant, immediate preoperative liver irradiation, and early postoperative chemotherapy. There were no postoperative deaths, and morbidity included mainly hematologic toxicity of chemotherapy. Two patients died of tumor recurrence 6 and 14 months after transplant. The remaining 5 patients are alive and free of disease with a follow-up of 7 to 26 months. These results show the feasibility of aggressive adjuvant therapy in patients transplanted for hepatocellular carcinoma and suggest a possible effect of such a protocol on the prevention of tumor recurrence.

Adult↗
PubMed1992

Expression of intermediate filament proteins in TPA-induced MPC-11 and HL-60 cells.

Under normal culture conditions, the tumor cell lines MPC-11 and HL-60 exhibit high rates of proliferation and show a peculiar expression of intermediate filament proteins as they appear to synthesize only lamin B. A 48-h exposure of murine plasmacytomas MPC-11 to the phorbol ester TPA reduces their growth and induces vimentin synthesis without affecting the composition of their nuclear lamina. When applied to human leukemic promyelocytes HL-60, such treatment promotes their maturation into macrophage-like cells: their proliferative ability is suppressed, a differentiated phenotype is developed, and their content in intermediate filament proteins now includes vimentin and a full complement of lamins A, B, and C. In the present study, a kinetic analysis of vimentin and lamin A/C expression in relation to proliferation and differentiation has been performed in these two cellular systems. Proliferation rates of MPC-11 and HL-60 populations were evaluated by monitoring cell growth and measuring thymidine incorporation. Maturation of HL-60 cells was assessed by Giemsa staining and percentage of adherent cells. Expression of vimentin and lamins A/C was analyzed using immunofluorescence and immunoblotting techniques. Our data show that there is a relationship between the level of vimentin expression and the extent of growth inhibition in both systems. They also suggest that the expression of lamins A/C during the TPA-induced maturation of HL-60 promyelocytes might be part of the processes which lock these cells into the macrophage pathway.

Animals↗
PubMed1992

Cellular reaction to the Vascugraft polyesterurethane vascular prosthesis: in vivo studies in rats.

The biocompatibility of Vascugraft, a polyesterurethane vascular prosthesis manufactured by Braun-Melsungen AG, was assessed by immunofluorescence and histological studies. Discs, 1 cm2, of Vascugraft prosthesis were implanted into the peritoneal cavity of rats. Results were compared with Impra, GORE-TEX and Mitrathane prostheses and a control group. Animals were killed at 1, 2, 6, 9 and 12 wk. Total T cells, T helper cells, T suppressor cells and activated T lymphocytes expressing Interleukin-2 receptors were quantified by a cytofluorometric technique in the peripheral blood of rats. For each period of implantation, all vascular prostheses showed no significant change in the percentage of total T cells, T subsets and T cells expressing Interleukin-2 receptors when compared to the control group. Histological examination of the tissue reaction surrounding the Vascugraft revealed a mild inflammatory reaction, similar to the one observed with both polytetrafluoroethylene grafts. However, the rate and the degree of encapsulation were different between grafts. The Vascugraft prosthesis was well encapsulated 2 wk after implantation, whereas inhibition of fibroblastic proliferation into the graft wall and surrounding both polytetrafluoroethylene grafts was observed for each period of implantation. The Mitrathane prosthesis exhibited a moderate inflammatory response, characterized by a high level of activation on fibroblasts compared to other grafts.

Animals↗
PubMed1992

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↗
PubMed1992

The effects of speech and language therapy for a case of dysarthria associated with Parkinson's disease.

We report the results of a single-subject multiple baseline across behaviours experiment of a 74-year-old woman presenting with Parkinson's disease. Her speech was typical of a hypokinetic dysarthria. The main features of her dysarthric speech were: a restriction in the modulation of fundamental frequency, an inappropriate pitch level and a rate disturbance. Three measures of prosody were operationally defined as follows: (1) linguistic modulation of fundamental frequency, (2) mean fundamental frequency and (3) rate. Treatment focused on ameliorating these aspects employing a multiple baseline design. Measures during and post-therapy documented improvement for each of these three aspects of prosody. Independent judges were also more capable of understanding her speech and her speech prosody after therapy. Upon follow-up measures 10 weeks later, most of the improvement was maintained.

Aged↗
PubMed1992

Polyadenylic-polyuridylic acid as an adjuvant in resectable colorectal carcinoma: a 6 1/2 year follow-up analysis of a multicentric double blind randomized trial.

In a double blind study, patients with operable carcinoma of the colon and the upper rectum, who have undergone a macroscopically complete resection of their tumor, were randomized to receive either (i) polyadenylic-polyuridylic acid (AU), one i.v. injection of 60 mg (in 50 ml of solution) once a week for 6 weeks, or (ii) a placebo (P) one i.v. injection of 50 ml of a saline solution with the same schedule. From January 1983 to December 1986, 288 patients were enrolled: 145 in AU group and 143 in P group. The main clinical and pathological characteristics were equally distributed throughout the two groups. There was a significant difference (P < 0.02) in the overall survival (OS) between the two groups, in favor of the P group. The 5-year OS rate was 68% (SD = 4%) in the AU group versus 81% (SD = 3%) in the P group. Thus, AU as a single adjuvant, appears to be ineffective and therefore has no indication in the treatment of colorectal carcinoma.

Aged↗
PubMed1991

Conservative treatment for breast cancer: long-term results (15 years).

From 1961 to 1974, 245 patients with unilateral "operable" breast cancer (25% T1, 56% T2, 19% T3) were treated with breast conservation and irradiation at the Gustave Roussy Institute (1961-1969) or at the Henri Mondor Hospital (1970-1974). The minimum follow-up is 15 years. Most patients with T greater than 3 cm underwent radiation therapy with the tumor in place, while the greater part of patients with T less than 3 cm received radiation therapy after tumorectomy. The breast and draining lymph node areas received widefield telecobalt irradiation to 45 Gy. The dose to the tumor site was boosted using iridium-192 implantation. Additional irradiation was given to the internal mammary and lower axillary nodes using an electron beam. The 15 years NED survival rate was 63%, 51% and 26% for T1, T2 and T3 tumors, respectively. The NED survival for T less than or equal to 1 cm was 86%. The local recurrence rate was 8, 12 and 19% for T1, T2 and T3 tumors, respectively. Of the patients with local recurrence, 85% underwent surgical salvage. Complications were rare. Cosmetic results were satisfactory in most patients including the T3 group. The proportion of breasts conserved among patients living NED at 15 years, was 97, 88 and 93% for T1, T2 and T3 tumors, respectively. In 1980, after almost 20 years experience using breast conserving techniques, we modified our treatment policies in close collaboration with our surgical team, hel cbye extending the indications for tumorectomy and associating routine surgical exploration of the lower axilla.

Breast Neoplasms↗
PubMed1991

External irradiation prior to conservative surgery for breast cancer treatment.

From 1981 to 1987, 138 patients with breast cancer unsuitable for primary tumorectomy received initial external radiotherapy (45 Gy/25f/35d) in order to reduce the tumor volume so that secondary limited surgery could be performed. There were 81 T2 and 57 T3. Fifty-seven percent of the patients had a tumor larger than 4.5 cm. After completion of the radiotherapy, 22 patients (16%) showed no more evidence of a tumor either clinically or radiologically and received a boost of 25 Gy. In 52 cases (38%) the tumor regression allowed for secondary tumorectomy followed by a boost of 20 Gy. Sixty-four patients (46%) showed either little or no tumor regression: radical surgery was performed in 14 cases (10%) and high dose boost curietherapy (37 Gy) in the 50 (36%) remaining patients who refused mastectomy. Breast conservation in good condition was thus obtained in 74 patients (54%). Sufficient tumor regression to allow secondary tumorectomy was more often observed in T2 than in T3, in poorly differentiated tumors or mucinous type, and in tumor with well defined mammographic aspects. Actuarial 5-year local control and disease-free survival rates after limited surgery were, respectively, 90% and 73%. No particular complications were observed after secondary tumorectomy. This therapeutic approach is encouraging in patients with large T2 and T3 breast tumors, but a longer follow-up is required to assess definitive conclusions.

Breast Neoplasms↗
PubMed1990

[Can tumors of the breast larger than 3 centimeters be treated conservatively?].

Unlike small breast cancers, which are now treated conservatively by primary tumorectomy, the most important lesions (T2 and T3) as usually treated tumorectomy, the most important lesions (T2 and T3) as usually treated by mastectomy. However, in patients with these large lesions attempts may be made at conserving the breast with reliable oncological safety and good cosmetic results. Depending on clinical presentation, one or the other of two therapeutic approaches may be considered. The most common treatment is preoperative radiotherapy of 45 Gy which, in more than 50 p. 100 of the cases results in a tumoral regression that is sufficient for secondary tumorectomy to be performed. In some patients, the first-line treatment consists of wide tumoral excision as part of a reductive mammaplasty, followed by radiation.

Breast Neoplasms↗
PubMed1990

Conservative management of tumors of the rectum by radiotherapy and local excision.

Twenty-five patients with invasive adenocarcinoma of the rectum were treated by preoperative external irradiation (35 Gy), local excision, and peroperative placement of a plastic tube loop in the tumor bed for perioperative brachytherapy (20 or 25 Gy). Patients treated were too frail for radical resection (14 patients) or had refused a permanent colostomy (11 patients). With a mean follow-up of 40.5 months, there have been 5 patients with local relapse, 3 of whom had salvage abdominoperineal resections: 2 have no evidence of disease and 1 has developed distant metastatic disease. The 20 patients with local control have normally functioning sphincters; 1 has developed distant metastatic disease. This combined approach was designed to expand the curative role of local resection in carcinoma of the rectum. The surgical techniques are thoroughly described and the potential role and indications of this approach are discussed.

Adenocarcinoma↗