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Biomedical subjects

R Laugier

Publications and source records attributed to R Laugier.

At least 37 records · Page 2Linked to original sources
PubMed2000

Endoscopic treatment of the main pancreatic duct: correlations among morphology, manometry, and clinical follow-up.

BACKGROUND AND AIM: During the course of chronic pancreatitis, the gradual increase in the main pancreatic duct pressure is the main pathophysiological factor responsible for pain, but up to now, the intra ductal pressure has never been measured during and after endoscopic stenting and correlated with clinical results. Pressure measurements of this kind could thus provide objective information about the useful duration of stenting period. METHODS: Main pancreatic duct pressure was measured by performing endoscopic manometry on 13 chronic pancreatitis symptomatic patients (10 men, 3 women, mean age: 45.1+/-7.9 yr); clinical follow-up was carried out for a period of 29.0+/-16.1 mo. Before treatment, the main anatomical alteration present was a localized stenosis of the main pancreatic duct, i.e., one with a diameter of less than 2 mm (chronic pancreatitis alone), 10 cases; chronic pancreatitis associated with pancreas divisum, 3 cases). Stenosis was treated by endoscopic stenting: 7 F stent (7 cases) and 12 F stent (6 cases). The pressure was measured simultaneously in the duodenum (zero level) and within the main pancreatic duct, using an electronic device, The pancreatico-duodenal gradient was taken to be the difference between the pressure in the main pancreatic duct and the duodenum. RESULTS: The endoscopic stenting induced a nonsignificant decrease in the intraductal pressure (p = 0.16). Among the 9 patients with a normal pressure at the end of the stenting and a successful anatomical outcome, 6 were painless during the follow-up period whereas 3 presented with recurrent pancreatic-type pain. The remaining 4 patients were symptom-free during the entire follow-up period, although the main pancreatic duct pressure was high at the end of the stenting and the stenosis was not completely cured. CONCLUSION: The intraductal pressure at the end of the stenting period was perfectly correlated with the anatomical result, whether or not it was successful, but was not an accurate predictor of a favorable clinical outcome in patients with a poor anatomical result.

Adult↗
PubMed1999

Development of a disease specific quality of life (QoL) questionnaire module to supplement the EORTC core cancer QoL questionnaire, the QLQ-C30 in patients with pancreatic cancer. EORTC Study Group on Quality of Life.

There is overwhelming consensus that quality of life assessment is urgently required in pancreatic cancer, yet little research has been conducted. We report on the development of a disease specific questionnaire module to supplement the EORTC core cancer module, the QLQ-C30 in patients with pancreatic cancer, using EORTC quality of life study group guidelines for module development. Relevant QoL issues were generated from literature searches and interviews with health professionals and patients with pancreatic cancer. Issues were constructed into items and provisionally translated. The provisional module was pretested in patients in 8 European centres. The resulting module the QLQ-PAN26 includes 26 items related to disease symptoms, treatment side-effects and emotional issues specific to pancreatic cancer. This should ensure that the module will be sensitive to assess the small but important disease and treatment related QoL changes in pancreatic cancer. The use of the QLQ-C30 and QLQ-PAN26 will provide a comprehensive system of QoL assessment in international trials of pancreatic cancer.

Adult↗
PubMed1998

Sphincter of Oddi manometry. Paradoxical response to secretin but not to CCK in alcoholic patients with no pancreatic disease.

CONCLUSION: In chronic alcohol abusers with no pancreatic disease, secretin was found to induce a paradoxical spasmodic response in the sphincter of Oddi (SO) instead of the relaxation observed in controls. Cerulein, on the contrary, had a normal relaxing effect on the SO. BACKGROUND: We previously reported SO dyskinesia in cases of chronic pancreatitis. Here we investigated whether chronic alcohol consumption may have contributed to the genesis of this dyskinesia. METHODS: SO and main pancreatic duct pressures were recorded endoscopically with a dual electronic pressure sensor in 27 chronic alcohol abusers and compared with the values obtained in 15 normal controls. These pressures were recorded both in the basal state and after applying hormonal stimulation by injecting either secretin (1 CU/kg) or cerulein (75 ng/kg). RESULTS: Cerulein relaxed the SO in both the controls and the chronic alcohol abusers, whereas it transiently enhanced the main pancreatic duct (MPD) pressure. Secretin induced a wave of MPD hyperpressure (+15.4 +/- 3.0 mm Hg) in both groups of subjects, but in the alcoholic group, instead of relaxing SO, it significantly enhanced the amplitude of phasic contractions (+32.6 +/- 8.4 mm Hg). The SO basal pressure was also paradoxically enhanced by secretin in the alcoholic patients (28.8 +/- 8.2 vs 10.1 +/- 2.4 mm Hg).

Alcoholism↗
PubMed1998

Endoscopic ductal drainage may avoid resective surgery in painful chronic pancreatitis without large ductal dilatation.

CONCLUSION: Endoscopic stenting treatment, in cases of chronic pancreatitis unsuitable for decompressive surgery, appears to be safe and efficient. Perfect anatomical results are only obtained if large stents are used after balloon dilatation. BACKGROUND: Decompressive surgery in cases of painful chronic pancreatitis is only feasible if the main pancreatic duct exceeds approx 8 mm over a sufficient length. When those anatomical changes are not present, surgery must be resective. This study evaluates the results of endoscopic stent drainage and decompression of painful chronic pancreatitis without large dilatation of the main pancreatic duct. METHODS: Sixteen of our chronic pancreatitis patients were included in this study. They presented a mean of 5.3 episodes of pain in the 6 mo before treatment. Decompressive surgery was not possible because of a mean pancreatic duct diameter of 5.8 mm. Stents were 7F in eight patients and 12F in the other eight. They were left in the duct after endoscopic dilation for 9.5 +/- 1.0 mo. RESULTS: During stenting we observed two early obstructions and seven episodes of pain. All cysts disappeared and stenosis of the duct disappeared anatomically in six cases, was improved in four, but persisted in six. During follow-up, two episodes of mild pain were recorded. No cysts reappeared. Complete disappearance of stenosis was only observed in patients whose pancreatic duct was equipped with a 12F stent (p < 0.02).

Adult↗
PubMed1998

Endoscopic treatment in chronic pancreatitis.

Endoscopic treatment of chronic pancreatitis has drawn benefits from endoscopic procedures previously described for the main bile duct. Endotherapy is developing throughout the world. Cyst drainage procedures certainly represent the largest step forward in that non-surgical approach, whatever it is either direct (through the stomach or the duodenum) or indirect through the papilla in the duodenum. This procedure gives similar results to surgery with a lower morbidity. Pancreatic duct drainage associated with stone clearance is feasible and provides good results which have not yet been compared with those obtained thanks to surgery. Nonetheless, when the duct is not widely dilated it has been proven to be a satisfactory alternative to surgery. By contrast, chronic cholestasis does not appear to be a good indication of endotherapy.

Cholestasis↗
PubMed1997

In vivo and in vitro studies on the stereoselective hydrolysis of tri- and diglycerides by gastric and pancreatic lipases.

The stereoselectivity of dog gastric and dog pancreatic lipases was investigated both in vitro, under simulated physiological conditions, and in vivo, during the digestion of a liquid test meal. In vitro it was observed that although both lipases had a stereopreference for the sn-3 position in triglycerides, it was about three times higher in the case of the gastric lipase. On the other hand, both lipases clearly showed a comparable enantioselectivity for the sn-1 position when a racemic diolein was used as the substrate. In the case of pancreatic lipase, the enantiomeric excess of 1,2-sn-diolein generated in vitro by the hydrolysis of triolein was found to decrease significantly, and even to be slightly reversed, at high rates of hydrolysis (above 50%) due to the further stereoselective hydrolysis of diglycerides into monoglycerides. This finding may explain the low enantiomeric excess of the diglycerides observed in vivo during the early phase of intraduodenal digestion when pancreatic lipase plays a predominant role and the rate of triolein hydrolysis is already high. On the other hand, a large enantiomeric excess of 1,2-sn-diolein generated from triolein was always the fingerprint of the gastric lipase in vitro even at high hydrolysis rates. This fingerprinting of gastric lipase was observed during both the intragastric phase and the late intestinal phase of lipolysis. This feature was therefore taken as an index to determine the respective roles of gastric and pancreatic lipases during in vivo lipolysis. To the best of our knowledge, this is the first time that stereoselectivity has been used as a tool to discriminate between the activities of two enzymes hydrolyzing the same substrate in vivo.

Animals↗
PubMed1997

Endoscopic drainage of pancreatic pseudocysts guided by endosonography.

Endoscopic drainage of cysts is now accepted as an effective treatment in chronic pancreatitis. Endosonography is coming to be regarded as essential before endoscopic therapy, since it can precisely identify the best and safest point at which to perform the cystoenterostomy. The present report illustrates from four cases that, in some patients, endosonography may contraindicate endoscopic drainage, while in others, it can prove the feasibility of the treatment even when there is no bulging of the cyst into the digestive tract.

Adult↗
PubMed1996

[Classification and clinical presentation of pancreatitis].

All pancreatitis share identical clinical features, which are evocative of a pancreatic disease; the diagnosis will be established by an enhanced level of pancreatic enzymes in the blood. Actually, we have to consider of one hand acute pancreatitis which heal completely when the cause has been treated (whatever it is of pancreatic or of extra-pancreatic origin) and on the other hand chronic pancreatitis characterized by the presence of fibrosis. Among chronic pancreatitis, one distinguishes chronic obstructive pancreatitis, upstream of an obstacle on the main pancreatic duct from chronic calcifying pancreatitis which is characterized by a diffuse, heterogeneous destruction of acinar tissue, replaced by dense fibrosis, the main etiology of which still remains alcohol.

Acute Disease↗
PubMed1996

Two forms of hereditary chronic pancreatitis.

We report 11 families of hereditary pancreatitis characterized by the presence of calculi in pancreatic ducts. These were classified as (1) calcic lithiasis (one family with five cases), in which the calculi are composed of >95% calcium salts; and (2) protein lithiasis in 10 families, in which the calculi are composed of degraded amorphous residues of lithostathine, the pancreatic secretory protein that inhibits calcium salt crystallization. In both forms, transmission appears to be dominant. The average age at clinical onset of symptoms is 15 years. The clinical progression seems to be less severe than in alcoholic chronic pancreatitis (alcoholic calcic lithiasis). This report shows for the first time that hereditary chronic pancreatitis is a group of at least two diseases having a similar clinical picture and pathological features but different chemical compositions of calculi. This leads us to propose a revised Marseille-Rome classification.

Adult↗
PubMed1994

Pancreatic lesions and modifications of pancreatic juice in tropical chronic pancreatitis (tropical calcific diabetes).

Seventeen Indian patients from Kerala State and 13 Indian controls were submitted to a dietary inquiry. Indian patients and controls had a low fat intake (40.8 g +/- 12.1 and 34.5 g +/- 11.0 per day, respectively) and a moderately low protein intake (52.8 +/- 9.5 and 47.8 +/- 11.3 g per day); 11 patients and 6 controls did not consume cassava. Pure nonactivated pancreatic juice was collected at endoscopy in 10 Indian patients who presented with tropical calcific diabetes, 12 apparently normal controls from the same area, and 23 apparently normal French controls. The only significant differences between Indian and French controls was a decreased pancreatic protein response to cerulein and an increased calcium concentration in the Indian subjects. The pancreatic juice of Indian patients was characterized by decreased volume, normal bicarbonate concentration, increased protein concentration when the acinar cells were not stimulated, with no response to cerulein, increased calcium concentration, and normal citrate concentration. These changes are very similar to the changes observed in French patients with chronic alcoholic pancreatitis. The lesions of 14 surgical resection pancreatic specimens from South Indian patients presenting with tropical pancreatitis were compared to pancreata from French patients presenting with chronic alcoholic pancreatitis. The only difference was that intraductal plugs, lesions of the duct epithelium, and retention cysts or pseudocysts were less frequent in Indians. These results show that the two nutritional forms of pancreatic lithiasis, alcoholic and tropical, have similar histological lesions and biochemical modifications of pancreatic juice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Dynamic endoscopic manometry of the response to secretin in patients with chronic pancreatitis.

Endoscopic manometry of the sphincter of Oddi and the main pancreatic duct (MPD) was performed before and after intravenous injection of secretin (1 CU/kg) in 15 control subjects and 19 patients with chronic pancreatitis. Secretin significantly but transiently enhanced the MPD pressure in the controls, whereas chronic pancreatitis patients had an elevated basal MPD pressure and a manometric pattern of sphincter of Oddi dyskinesia. The secretin-induced MPD pressure was also elevated and more sustained in chronic pancreatitis patients compared to controls. No influence of the etiology or MPD ductal diameter was found, but the duration of the disease correlated significantly to the pressure response to secretin in patients. The pressure enhancement was most impressive in chronic pancreatitis of recent onset (less than four years), whereas it was minimal or normal in later stages of the disease. This dynamic manometric test reliably demonstrates sphincter of Oddi dysfunction and an altered response to secretin. The test could have a role to play in the explanation of progressive MPD dilatation as well as in the early diagnosis of chronic pancreatitis.

Adolescent↗