[Laparoscopic discovery of disseminated peritoneal leiomyomatosis closely resembling metastatic peritoneal carcinomatosis].
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Carcinoma↗
Biomedical subjects
M Legrand
Publications and source records attributed to M Legrand.
[Surgery of esophageal cancer in Liège: III. Clinical and radiographic evaluation of long-term quality of life after esophagectomy].
OBJECTIVE: Functional evaluation of digestive transplants after oesophagectomy for cancer. MATERIAL AND METHODS: We evaluated alimentary comfort and quality of life and performed a videofluoroscopy (radiocinema) in 34 patients who were alive and disease-free one year or more after oesophagectomy for malignancy. There were 22 males and 12 females; mean age was 64 years. Twenty-three patients had a gastric pull-up and 11 a colonic graft. Mean follow-up was 36 months (range: 12-100 months). Possible correlations between clinical symptoms and radiographic observations were studied with Fisher's exact test. RESULTS: Most-cited symptoms were gurgling in 16 patients, early fullness during eating in 15, diarrhea in 14, postprandial sweating in 9, pyrosis in 8, nocturnal cough in 7, and dysphagia in 5. Most patients considered the side effects of the operation as mild to moderate and mean rating of alimentary comfort was 7.6/10. Twenty-five patients qualified their quality of life as good, 8 as satisfactory, and 1 as poor. Twenty-nine patients led active lives. Videofluoroscopic evaluation showed that colonic grafts emptied mainly by gravity, while active contractions were observed in the antrum of gastric transplants. There was a significant correlation between alimentary symptoms and radiographic distension of the transplant. Oro-pharyngeal abnormalities, site of proximal anastomosis, nature, motility, or active versus passive emptying of the transplant did not correlate with clinical complaints. CONCLUSIONS: In most patients quality of life and alimentary comfort are good after oesophagectomy and gastric or colonic interposition. Radiocinema is an adequate method to evaluate the dynamic of the transplant and shows a better emptying of gastric grafts, compared to colonic grafts, particularly when the proximal portion of the oesophagus triggers the progression.
Adult↗
Laparoscopic repair of perforated duodenal ulcer. A prospective multicenter clinical trial.
BACKGROUND: A series of 100 consecutive patients with perforated peptic ulcer were prospectively evaluated in a multicenter study. The feasibility of the laparoscopic repair was evaluated. METHODS: All patients had peritonitis, 20% were in septic shock, and 57% had delayed perforation. Conversion to laparotomy was necessary in eight patients. The morbidity rate was 9% and mortality rate 5%. RESULTS: The mean delay of postoperative gastric aspiration (mean 3.4 days) and resumed food intake (mean 4.4 days) as well as the mean postoperative hospital stay (mean 9.3 days) were comparable to conventional surgery, but postoperative comfort was subjectively increased by laparoscopy and noticed by all laparoscopic surgeons participating in this study. CONCLUSIONS: Laparoscopic repair of perforated peptic ulcer proves to be technically feasable and carries an acceptable morbidity and mortality rate, compared with conventional surgery.
Adolescent↗
The dramatic reality of biliary tract injury during laparoscopic cholecystectomy. An anonymous multicenter Belgian survey of 65 patients.
BACKGROUND: Most reports concerning the outcome of patients with biliary tract injury during laparoscopic cholecystectomy come from tertiary referral centers, and results could be very different in the everyday practice of community surgeons. OBJECTIVE: The objective is to define the presentation, mechanisms, results of treatment, and long-term outcome of biliary tract injuries during laparoscopic cholecystectomy in the setting of a community surgeon's practice. METHODS: An anonymous retrospective multicenter survey of 9,959 patients who underwent laparoscopic cholecystectomy was conducted by the Belgian Group for Endoscopic Surgery, composed mainly of community general surgeons. RESULTS: Sixty-five patients with bile duct injury were reported on; the incidence was 0.5%, varying from 0. 35 to 1.3% according to the experience of the surgeon. Thirty-four percent of ductal injuries occurred with experienced surgeons, often in association with local predisposing risk factors. Injury occurred in 87% of cases during dissection of the Calot triangle, with severe injury occurring in 46% of patients. Intraoperative cholangiography was performed in 34% of patients and was associated with a significantly improved operative detection rate of injury (68% vs 32%, p = 0.007). Operative detection of injury occurred in 45% of patients; diffuse bile ascitis was encountered postoperatively in 29%. The overall mortality was 9%, the postoperative biliary complication rate 31%, and the reintervention rate 14%. During a median follow-up of 49 months (range, 3-78 months), 20 of the 61 surviving patients (33%) had recurrent biliary strictures. Multivariate analysis demonstrated that the age of the patient (odds ratio: 0.893) and the presence of biliary peritonitis (odds ratio: 0.061) were independent predictive factors for mortality and that the age of the patient (odds ratio: 1.049) and the occurrence of postoperative biliary complications (odds ratio: 0.161) after the initial biliary repair were independent predictive factors for late biliary stricture. CONCLUSIONS: Biliary tract injury is associated with significant mortality and complications in the practice of Belgian community surgeons. Intraoperative detection of ductal injury by the routine use and a correct interpretation of intraoperative cholangiography improved outcome. The impact of the primary biliary repair on long-term outcome is an argument to refer these patients to specialized multidisciplinary experts. The results highlight the importance of surgical experience, proper selection of patients for laparoscopic cholecystectomy, and conversion to laparotomy in difficult cases.
Adult↗
Polymorphism of the cytochrome P450 CYP2D6 gene in a European population: characterization of 48 mutations and 53 alleles, their frequencies and evolution.
The polymorphic cytochrome P450 CYP2D6 is involved in the metabolism of various drugs of wide therapeutic use and is a presumed susceptibility factor for certain environmentally-induced diseases. Our aim was to define the mutations and alleles of the CYP2D6 gene and to evaluate their frequencies in the European population. Using polymerase chain reaction-single strand conformation polymorphism analysis, 672 unrelated subjects were screened for mutations in the 9 exons of the gene and their exon-intron boundaries. A total of 48 point mutations were identified, of which 29 were novel. Mutations 1749 G-->C, 2938 C-->T and 4268 G-->C represented 52.6%, 34.3% and 52.9% of the mutations in the total population, respectively. Of the eight detrimental mutations detected, the 1934 G-->A, the 1795 Tdel and the 2637 Adel accounted for 65.8%, 6.2% and 4.8% respectively, within the poor metabolizer subgroup. Fifty-three different alleles were characterized from the mutation pattern and by allele-specific sequencing. They are derived from three major alleles, namely the wild-type CYP2D6*1A, the functional CYP2D6*2 and the null CYP2D6*4A. Five allelic variants (CYP2D6*1A, *2, *2B, *4A and *5) account for about 87% of all alleles, while the remaining alleles occur with a frequency of 0.1%-2.7%. These data provide a solid basis for future epidemiological, clinical as well as interethnic studies of the CYP2D6 polymorphism and highlight that the described single strand conformation polymorphism method can be successfully used in designing such studies.
Alleles↗
[Celioscopic approach in surgical treatment of morbid obesity. Technique and results].
Three hundred and twenty Laparoscopic Adjustable Silicone Gastric Banding (LASGB) procedures have been performed in our institution from September, 1993 to January, 1997 for the treatment of morbid obesity. Before the first human operation a new prototype of the silicone band for laparoscopic use has been devised and a new surgical protocol developed in a preliminary animal lab programme. All the patients were morbidly obese (92-200 kg). The conversion rate to laparotomy has been very low (1.25%). Early complications have been rare. Pouch dilatation and/or stomach slippage has been the only significant late complication. The rate of this complication has been considerably improved by reducing the pouch volume and by putting more gastro-gastric sutures. The post-operative weight loss of LASGB has been comparable with our series of VBG and ASGB.
Adolescent↗
[Communicating the worsening condition or death of a patient].
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Communication↗
An additional allelic variant of the CYP2D6 gene causing impaired metabolism of sparteine.
The identification of a novel CYP2D6 allele from a healthy Caucasian poor metabolizer was achieved by using a previously described polymerase chain reaction/single-strand conformation polymorphism strategy. Among the four point mutations that this allele carries, a missense mutation in exon 1 (212 G-->A or D6-H) seems to be responsible for the loss of CYP2D6 function. Although the mutation D6-H has a low prevalence in a randomly selected population of healthy Caucasians, its identification should further increase the phenotype prediction rate by genotyping.
Alleles↗
Laparoscopic treatment of nonparasitic liver cysts: adequate selection of patients and surgical technique.
Results of laparoscopic fenestration in patients with a highly symptomatic solitary liver cyst (17 patients) or polycystic liver disease (PLD) (9 patients) were prospectively evaluated in a multicenter practice of general surgeons. Conversion to laparotomy was required in two patients because of inaccessible deep liver cyst in one and a diffuse form of PLD in the other. There was no mortality or major morbidity. Mean postoperative hospital stay was 4.6 days after successful laparoscopic procedures. During a mean follow-up of 9 months, 23% of the patients had recurrence of symptoms and 38% had radiographic reappearance of cysts. Factors predicting failure included previous surgical treatment, deepsited cysts, incomplete deroofing technique, location in the right posterior segments of the liver, and a diffuse form of PLD with small cysts. Adequate selection of patients and type of cystic liver disease and meticulous and aggressive surgical technique are recommended.
Adult↗
Influence of a mutation reducing the catalytic activity of the cytochrome P450 CYP2D6 on lung cancer susceptibility.
The possible association between lung cancer and the CYP2D6*9 mutant allele, which reduces the catalytic activity of cytochrome P450 CYP2D6, was examined by PCR-SSCP using peripheral blood DNA from 249 cases of lung cancer and 265 controls, with detailed data on smoking. The CYP2D6*9 mutant allele was present in 4.9% of controls and 6% of cases. Adjusted for age, hospital and smoking, the odds ratio (OR) of lung cancer associated with the presence of the CYP2D6*9 mutant allele was 1.2 [95% confidence interval (CI) 0.5-2.9]. According to histological type, adenocarcinoma and small cell carcinoma were not associated with the presence of the CYP2D6*9 mutant allele and a non-significant higher occurrence of the mutant allele was observed for squamous cell carcinoma (OR 1.74, 95% CI 0.6-4.8). Moreover, no associations were observed upon stratification by number of pack-years of cigarette smoking. These results do not confirm an earlier report that this CYP2D6*9 mutant allele may be an additional risk factor for the development of lung cancer.
Alleles↗
Expression of class I O-methyltransferase in healthy and TMV-infected tobacco.
Tobacco possesses two distinct classes of O-methyltransferases (OMTs; S-adenosyl-L-methionine:o-diphenol O-methyltransferases; EC 2.1.1.6). Here we report on the cloning and the expression pattern of the class I OMT that is specifically involved in lignin biosynthesis. Near-full-length cDNAs have been isolated from tobacco libraries constructed from leaf and stem poly(A)+ RNA. Sequence analysis demonstrated that the OMT I clones derived from two different mRNA species. The two types of OMT I mRNA were reverse transcribed from total RNA and the cDNAs were amplified by polymerase chain reaction and characterized by restriction analysis. The same proportion of the two transcripts was measured in stem tissue of healthy plants and in leaves reacting hypersensitively to tobacco mosaic virus, indicating a coordinate expression of the two OMT I genes. Consistently, genomic hybridization indicated the presence of two OMT I genes in the amphidiploid genome of tobacco. The pattern of expression of OMT I genes was studied by in situ mRNA hybridization. In stem, petiole, and root tissues, OMT I genes were found to be specifically expressed in vascular cells and epidermis. In healthy leaves OMT I mRNA was only detected in vascular strands, whereas, in leaves bearing tobacco mosaic virus-induced necrotic lesions, a particularly strong accumulation of the labeling was also localized in the upper and lower epidermis.
Amino Acid Sequence↗
A nonsense mutation in the cytochrome P450 CYP2D6 gene identified in a Caucasian with an enzyme deficiency.
A novel mutation that generates a stop codon in the third exon of the gene encoding the cytochrome P-450 CYP2D6 was identified in a Caucasian having a deficiency of the isozyme, by means of single strand conformation polymorphism analysis of DNA fragments amplified by the polymerase chain reaction, followed by selective sequencing.
Base Sequence↗
A novel CYP2D6 allele with an abolished splice recognition site associated with the poor metabolizer phenotype.
A novel loss-of function allele of the CYP2D6 gene was characterized in a PM individual using exon-by-exon PCR-SSCP analysis. This allele, we termed CYP2D6(F), harbours four mutations including a new mutation (D6-F) which abolishes the splice acceptor site of the 1st intron and results in a premature stop codon. DNA samples from a large population of healthy unrelated volunteers were tested for D6-F using a PCR-assay we developed for the specific identification of the mutation in genomic DNA. The prevalence of D6-F was very low. However, its identification combined with that of the previously reported gene inactivating mutations would further increase the phenotype prediction rate by genotyping.
Alleles↗
An efficient strategy for detection of known and new mutations of the CYP2D6 gene using single strand conformation polymorphism analysis.
To detect mutations in the cytochrome P450 CYP2D6 gene (CYP2D6), we developed a strategy based on single-strand conformation polymorphism (SSCP) analysis of the gene amplified by polymerase chain reaction (PCR). The efficiency of the method was evaluated by analysing DNA samples from extensive metabolizers (EM) and poor metabolizers (PM) of debrisoquine. Haplotypes, alleles and mutations of CYP2D6 had previously been characterized in each individual using PCR assays, Xba I restriction fragment length polymorphism (RFLP) and sequencing. PCR-SSCP results were in complete agreement with those obtained using established methods. All previously characterized mutations were associated with particular shifts in the electrophoretic mobility of DNA fragments allowing their identification. We further tested the efficiency of PCR-SSCP for detecting new CYP2D6 mutations. DNA from a PM subject presumed to carry an unknown non-functional mutant allele of CYP2D6 was amplified and bands with aberrant migration patterns were observed on SSCP gels. Sequence analysis of the corresponding DNA fragments revealed the causative mutations. In this way, a novel non-functional allele of the gene, carrying three previously reported mutations and a new mutation in the third exon which results in a premature termination codon, was characterized. Finally, CYP2D6 SSCP analysis was performed on DNA amplified with fluorescent primers and an automated DNA sequencer was used for SSCP analysis of products. We conclude that the PCR-SSCP approach is a powerful method of identifying simultaneously known and new mutations of the CYP2D6 gene.
Alleles↗
Pathogenesis-related PR-1 proteins are antifungal. Isolation and characterization of three 14-kilodalton proteins of tomato and of a basic PR-1 of tobacco with inhibitory activity against Phytophthora infestans.
Three distinct basic 14-kD proteins, P14a, P14b, and P14c, were isolated from tomato (Lycopersicon esculentum Mill. cv Baby) leaves infected with Phytophthora infestans. They exhibited antifungal activity against P. infestans both in vitro (inhibition of zoospore germination) and in vivo with a tomato leaf disc assay (decrease in infected leaf surface). Serological cross-reactions and amino acid sequence comparisons showed that the three proteins are members of the PR-1 group of pathogenesis-related (PR) proteins. P14a and P14b showed high similarity to a previously characterized P14, whereas P14c was found to be very similar to a putative basic-type PR-1 from tobacco predicted from isolated DNA clones. This protein, named PR-1 g, was purified from virus-infected tobacco (Nicotiana tabacum Samsun NN) leaves and characterized by amino acid microsequencing, along with the well-known acidic tobacco PR-1a, PR-1b, and PR-1c. The various tomato and tobacco PR-1 proteins were compared for their biological activity and found to display differential fungicidal activity against P. infestans in both the in vitro and in vivo assays, the most efficient being the newly characterized tomato P14c and tobacco PR-1g.
Amino Acid Sequence↗
Laparoscopic Placement of Adjustable Silicone Gastric Band in the Treatment of Morbid Obesity: How to Do It.
BACKGROUND: laparoscopic placement of the adjustable silicone gastric band (ASGB) was begun in our institution in 1992. METHODS: this work started on the animal model first. In the animal laboratory, details of laparoscopic dissection around the pig's stomach were defined. A new prototype of the adjustable silicone band for laparoscopic use was devised. The first human laparoscopic ASGB procedure was performed in our institution on September 1, 1993; 37 patients have undergone this operation by May, 1994. There were 33 women and four men. The average pre-operative weight was 114 kg (92160 kg). The mean BMI was 42 kg m(2) (37-50 kg m(2)). RESULTS: no major operative difficulty has been encountered. Immediate post-operative outcome was uneventful except for one patient. CONCLUSION: the technique of laparoscopic ASGB is described. Preliminary weight loss is comparable to open ASGB and vertical gastroplasty, provided that the surgeon has mastered laparoscopy and open bariatric surgery.
Journal Article↗
Proximal and distal pulse pressure after acute antihypertensive vasodilating drugs in Wistar-Kyoto and spontaneously hypertensive rats.
OBJECTIVE: In a previous study (J Hypertens 1993, 11:135-139) our group showed that in anaesthetized rats, although pulse pressure increased from the proximal (common carotid artery) to the distal (terminal aorta) portion of the aorta in normotensive Wistar-Kyoto (WKY) rats, such a pulse pressure gradient was not observed in spontaneously hypertensive rats (SHR) which had identical values of proximal and distal pulse pressure. The purpose of the present study was to show, in awake SHR, in comparison with awake WKY rats, that the lack of pulse pressure gradient might be functionally reversed after acute administration of vasodilating agents. METHODS: The drugs (administered intra-arterially) were an angiotensin converting enzyme inhibitor (perindoprilat; 2 mg/kg), a calcium antagonist (nicardipine; 30 micrograms/kg), a peripheral vasodilator (hydralazine; 200 micrograms/kg) and placebo (isotonic saline). Blood pressure was evaluated invasively. RESULTS: In untreated rats it was noticed that pulse pressure increased physiologically from the proximal to the distal part of the aorta for the same mean arterial pressure in WKY rats, whereas no pulse pressure gradient was observed in SHR. With acute drug administration, marginal modifications were observed in WKY rats, but mean arterial pressure was reduced significantly in SHR (hydralazine > perindoprilat > nicardipine). Proximal pulse pressure was decreased significantly with perindoprilat or nicardipine but was unchanged with hydralazine. Distal pulse pressure was unchanged, except for an increase in the nicardipine-treated group. Heart rate was increased significantly by hydralazine. CONCLUSION: The results show that, although all of the drugs studied decreased mean arterial pressure in SHR, only the calcium antagonist nicardipine and the angiotensin converting enzyme inhibitor perindoprilat reduced proximal pulse pressure. This dissociation between the effects on mean arterial pressure and proximal and distal pulse pressure can be explained by the preferential action of the different antihypertensive agents on large arteries and wave reflections, producing different patterns in the pulsatile component of the heart load.
Angiotensin-Converting Enzyme Inhibitors↗
Molecular characterization of a novel tobacco pathogenesis-related (PR) protein: a new plant chitinase/lysozyme.
A new PR (pathogenesis-related) protein was isolated from tobacco leaves (Nicotiana tabacum cv. Samsun NN), reacting hypersensitively to tobacco mosaic virus (TMV), by zinc chelate chromatography and was therefore named Pz. Its reactivity toward several lectins indicated the presence of bound sugar residues. From the amino acid sequence of tryptic peptides, Oligonucleotide primers were derived which allowed the synthesis of Pz cDNA by PCR. Using this cDNA as probe, near full-length clones were isolated from a library made from poly(A)+ RNA purified from TMV-infected leaves. Sequence analysis revealed similarities with chitinases/lysozymes of various origins and the purified protein was, indeed, shown to hydrolyse different N-acetylglucosamine-containing substrates. Comparison of peptide and cDNA sequences indicated that Pz protein is synthesized as a pre-pro-protein, a seven-amino acid C-terminal peptide probably being involved in the vacuolar targeting of the protein. Pz mRNA and protein were demonstrated to accumulate strongly in TMV-infected tobacco leaves. Pz transcripts were also found in various tissues of healthy plants, indicating that Pz gene expression is developmentally regulated.
Amino Acid Sequence↗