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Biomedical subjects

P Ponsot

Publications and source records attributed to P Ponsot.

At least 37 records · Page 2Linked to original sources

[Epithelial gastric polyps in a series of 13000 gastroscopies].

The frequency and characteristics of epithelial gastric polyps were studied over a 4-years periods. In a series of 13,000 gastric fibroscopies, 191 patients (1.3 per cent) were fund to have a "polypous lesion". Among these, 48 had hyperplastic polyps, 19 had fundic gland polyps and 6 had adenomatous polyps. The remaining patients had either lesions of interstitial gastritis (118) or normal histology (34). Hyperplastic polyps were 5 mm large in 87 per cent of the cases, and 7 out of 10 were solitary. They were equally distributed between fundus and antrum and associated with atrophic gastritis in 9 out of 22 cases. In 2 cases, they were accompanied with gastric cancer. Fundic gland polyps were less than 5 mm large in 84 per cent of the cases and solitary in 5 out of 19 cases. Adenomatous polyps were associated with hyperplastic polyps in 4 patients, including 1 mixed polyp (hyperplastic containing adenomatous areas). Follow-up with regular endoscopic examinations is accepted for adenomatous polyps; it seems to be justified in patients with hyperplastic polyps, and lesions bigger than 10 mm should be removed in view of the as yet imperfectly evaluated risk of malignant degeneration.

Adult↗

[Dysphagia in oculopharyngeal myopathies. Report of 7 cases].

Swallowing disorders have been studied in seven patients with oculopharyngeal myopathy. All patients presented with symptoms dominated by solid food dysphagia and false passages. Two of them had a considerably deteriorated general and pulmonary condition. Manometry demonstrates a decrease in pharyngeal populsion in six patients but does not detect any anomaly in the function of the upper sphincter of the esophagus. Three patients were operated with myotomy of the cricopharyngeus. The procedure led to the disappearance of the disorders in two of them, while it was a failure in the third. Swallowing disorders, the difficulties of manometric exploration and the role of myotomy are discussed in this article.

Aged↗

[Echoendoscopy: a new technic for studying esophago-gastric subepithelial tumors and extrinsic compression].

The value of endoscopic ultrasonography in the diagnosis of subepithelial tumors and extrinsic compression of the esophagus and the stomach was evaluated in 34 patients with 21 subepithelial tumors and 13 extrinsic compressions. Endoscopic ultrasonography was always performed after axial-vision fiberscopy anal routine biopsy specimens were obtained. Computed tomography was also done in all cases of extrinsic compression. Distinction between subepithelial tumor and extrinsic compression was made in all patients by endoscopic ultrasonography and in 5 cases by fiberscopic examination with biopsy specimens. Localization and intramural spread of subepithelial tumors were correctly determined in 12 of 13 cases by endoscopic ultrasonography (diagnostic accuracy: 92 percent). The echoendoscopic semiology of 21 subepithelial tumors was retrospectively established. The histologic nature of some of these tumors can be suggested by these signs. Endoscopic ultrasonography is superior to computed tomography in the evaluation of esogastric extrinsic compressions, particularly in the diagnosis of posterior mediastinal carcinomatosis and of tumoral invasion of the deep parietal layers. We conclude that endoscopic ultrasonography is currently the best procedure in the assessment of subepithelial tumors and extrinsic compressions of the esophagus and the stomach.

Carcinoma↗

[Endoscopic ultrasonic diagnosis and cancer of the esophagus. Results of a prospective comparative study with x-ray computed tomography in 51 surgically treated patients].

To investigate whether endoscopic ultrasonography could improve the preoperative staging of esophageal carcinoma we prospectively studied 56 tumors in 51 patients between March 1987 an March 1988. The results for assessing local and regional extension and preoperative staging were compared with those of computed tomography, surgery, and pathological findings. When the procedure was complete (n = 25) the accuracy of parietal spread assessment was 85.7 percent; sensitivity for nodal involvement was 83.3 percent versus 50 percent for computed tomography with an accuracy of 97.6 percent versus 96.4 percent; the discrimination between superficial and advanced cancer was 100 percent; the accuracy for preoperative staging using the Japanese classification was 84 percent. When the procedure was not complete (stenosis), endoscopic ultrasonography was complementary to computed tomography: local invasion of anatomical structures (n = 16) was better assessed by combined endoscopic ultrasonography and computed tomography (n = 11) than by endoscopic ultrasonography (n = 8) or computed tomography (n = 6) alone. We conclude that endoscopic ultrasonography is the best procedure for staging esophageal carcinoma without stenosis; further miniaturization of the transducer is necessary to improve results in the case of narrow stenosis.

Adenocarcinoma↗

[Results of endoscopic ultrasonography in the preoperative assessment of rectal cancer].

Endoscopic transrectal ultrasonography is performed with an ultrasonic transducer (7.5 MHz or 12 MHz) in the tip of a side viewing endoscope. Its accuracy to assess the depth of rectal cancer invasion was prospectively studied in 27 patients. The ultrasonic examination was correct in 23 cases; in 4 cases, the stricturing tumour could not be passed by the probe. The depth of invasion was correctly appreciated in 24 of the 27 cases (accuracy of 89%). The 6 superficial lesions were all correctly detected with endoscopic transrectal ultrasonography. Therefore, endoscopic transrectal ultrasonography appears to be a very promising method in the pretherapeutic staging of rectal cancer.

Aged↗

[Intestinal lymphangiectasis secondary to cicatricial fibrosis of mesenteric nodes: a nosologic entity?].

Exsudative enteropathy was suspected in a 27-year-old man with lower limb edema, hypoprotidemia and hypoalbuminemia. Gastrointestinal mucosa, kidney, liver, and heart were normal. Laparoscopy showed diffuse small intestine lymphangiectasia. This diagnosis was confirmed by the microscopic examination of several biopsies obtained at laparotomy. Pathological examination of peritoneal, lymph nodes, and liver biopsies showed fibrous thickening of the peritoneum and fibrosis of the lymph nodes. Our patient has been followed for 16 years. Substantial improvement of clinical symptoms was obtained by following a special salt-free diet containing short-chain triglycerides. However biochemical abnormalities have persisted. Exsudative enteropathy due to intestinal lymphangiectasia may be observed in heart and liver diseases as well as in malignant affections of mesenteric lymph nodes. If these conditions are excluded, intestinal lymphangiectasia may be considered as a primitive lymph vessel malformation. The discovery of primitive intestinal lymphangiectasia in an adult cannot be attributed to congenital abnormalities alone. Fibrosis encountered in some cases suggests that an inflammatory process of unknown origin may trigger the onset of intestinal lymphangiectasia.

Adult↗

Endosonography: promising method for diagnosis of extrahepatic cholestasis.

Endosonography, ultrasonography, and computed tomography (CT) were carried out prospectively in 52 patients with extrahepatic cholestasis. 35 patients had extrahepatic biliary obstructions (21 tumorous, 14 non-tumorous) and 17, with recent gallstone migration within the bile duct, had no extrahepatic obstruction at the time of investigation. The definitive diagnosis was established by surgery (in 39 patients), by transendoscopic sphincterotomy (11 patients), or by retrograde biliary opacification (2 patients). Endosonography was significantly more sensitive than ultrasonography or CT (100% vs 80% and 83%, respectively) in making a positive diagnosis of obstruction. Endosonography was also significantly more accurate than ultrasonography or CT (97% vs 49% and 66%) in diagnosing the cause of the obstruction and more effective in the assessment of the locoregional spread of tumorous obstructions (75% vs 38% and 62%). Thus, endosonography was superior to ultrasonography and CT in the diagnosis and staging of biliary obstructions.

Adult↗

[Endoscopic ultrasonography of the digestive tract].

Endoscopic ultrasonography of the digestive tract provides for a precise ultrasonic study of the accessible gastrointestinal walls (oesophagus, stomach, duodenum, rectum) and, through these walls, of the adjacent organs (lymph node clusters, posterior mediastinum, pancreas, extrahepatic biliary ducts and perirectal environment). This method is better than computerized tomography to evaluate the local and regional extension of oesophageal and cardial carcinomas producing little or no stenosis and of rectal carcinomas. It is the examination of choice to detect a perianastomotic recurrence of these cancers and to evaluate submucosal tumours of the digestive tract and thick fold stomach diseases. Its use in the aetiological diagnosis of obstacles in the biliary tract and in the pretherapeutic assessment of pancreatic and biliary tract cancers seems to be very promising.

Biliary Tract Diseases↗

[Digestive lymphomatous polyposis: study of a case diagnosed by rectal biopsy].

We report a case of gastrointestinal lymphomatous polyposis revealed by a rectal tumor. Numerous polypoid lesions, 5 to 20 mm in diameter, were found at various levels of the gastrointestinal tract. Microscopic examination of gastric, duodenal, colic and rectal specimens led to the diagnosis of small cleaved-cell type lymphoma. The immunohistochemical study showed a monotypic surface staining of the lymphomatous cells with anti-IgM, IgD, kappa, C3b, and CD5 antibodies. This type of lymphoma is rare and presents as multifocal polyposis of the gastrointestinal tract. Only histologic and immunohistologic studies can establish diagnosis. Gastrointestinal lymphomatous polyposis is classified as a low-grade malignant lymphoma, with frequent nodal, hepatosplenic, bone marrow, and blood involvement. Chemotherapy is the appropriate treatment.

Aged↗

[Pancreatic cystadenoma: diagnostic value of ultrasonics and x-ray computed tomography].

We report six cases of pancreatic cystadenoma (three mucinous cysts, three microcystic adenomas). All patients were women. The mean age at the time of diagnosis was 50 years (with a range from 24 to 70 years). The mean age of patients having mucinous cysts (36.6 years) was lower than that of patients having microcystic adenomas (63.3 years). Abdominal pain was the first symptom in five patients. A palpable abdominal mass was found in three cases. The type of the tumor was demonstrated by ultrasonography and computed tomography and was confirmed by laparotomy in five cases. The tumors involved the body and tail of the pancreas. A distal pancreatectomy was performed in five cases, with a splenectomy in four cases. The post-operative course was uneventful. One patient was not operated. The histological examination of the three mucinous cysts showed benign tumors. This study emphasizes the usefulness of ultrasonography and computed tomography for the diagnosis of pancreatic cystadenomas. Surgical therapy is mandatory for mucinous cysts because of their potential malignancy, but a careful follow-up might be proposed for poor-risk patients having a microcyst adenoma, since this tumor is benign.

Adult↗