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S Evrard

Publications and source records attributed to S Evrard.

At least 37 records · Page 2Linked to original sources
PubMed1996

Laparoscopy not recommended for routine appendectomy in men: results of a prospective randomized study.

BACKGROUND: Laparoscopic appendectomy has now gained wider acceptance in clinical practice, particularly in the treatment of women with right iliac fossa pain. However, the precise role of laparoscopic appendectomy in men is unclear, and this study was therefore undertaken to examine this specific issue in a prospective randomized trial. METHODS: One hundred men between the ages of 16 and 65 years who had suspected appendicitis were recruited and randomized to undergo either open or laparoscopic appendectomy. Both groups were compared in terms of their clinical parameters, duration of anesthetic and operation times, postoperative pain, duration of ileus, and length of hospital stay. RESULTS: The histologic confirmation of appendicitis was present in 94% of the cases for both groups of patients. Laparoscopic appendectomy required significantly longer anesthetic time (72.5 minutes versus 55 minutes) and actual operating time (45 minutes versus 25 minutes) compared with open appendectomy. Postoperative pain as measured by visual analog scale on postoperative days 1 and 2 were not significantly different between the patients who underwent laparoscopic and open surgery with values of 4.7 versus 4.4 and 2.1 versus 2.2, respectively. Also no significant difference was seen between the laparoscopic and open appendectomy groups in the recovery of bowel function (24.7 hours versus 21 hours) and in the length of hospital stay (4.9 days versus 5.3 days). CONCLUSIONS: The results of this prospective randomized trial showed that there were no significant advantages of laparoscopic appendectomy over open appendectomy for the treatment of male patients with suspected appendicitis. We recommend that the use of laparoscopy be limited to men with atypical pain of uncertain diagnosis and in obese patients.

Adolescent↗
PubMed1996

Photodynamic imaging of a rat pancreatic cancer with pheophorbide a.

Laser-induced fluorescence of pheophorbide a (Ph-a) was used for in vitro photodynamic imaging (PDI) of a rat pancreatic acinar tumor. A 400 nm excitation induced a 470 nm autofluorescence and a 678 nm dye fluorescence in tumors and their surrounding pancreas 24 h after a 9 mg kg-1 body weight Ph-a intravenous administration. With lower intensities in these blood-rich tumors than in pancreas, Ph-a fluorescence signals are unable to provide tumor images. A dimensionless function (the ratio of Ph-a fluorescence by autofluorescence, called Rt for the tumor and Rp for the pancreas) was used for fluorescence contrast calculation (C = Rt/Rp) between six tumors and their paired pancreas. Among five available laser excitation wave-lengths, only the 355 nm excitation gave a distinctive contrast (C = 1.5). The PDI of six intrapancreatic tumors and their intraperitoneal metastasis and of two control normal pancreas was thus performed ex vivo using a 355 nm excitation source delivered by a tripled Nd:YAG laser and a charged-coupled device camera. Fluorescence images were recorded at 680 nm (dye), 640 nm (background) and 470 nm (autofluorescence) through three corresponding 10 nm width bandpass filters. Computed division for each pixel of Ph-a fluorescence values by autofluorescence generated false color image. In this way, contrasted tumor images were obtained. But in five out of six animals false-positive images were present due to an autofluorescence decrease in some normal pancreatic areas. A 470 nm autofluorescence imaging on the same tumors gave in all cases false-positive image and false-negative in half of the cases. These observations suggest that autofluorescence alone is unable to achieve accurate PDI of pancreatic carcinoma and that using Ph-a as a PDI dye needs strong improvements.

Animals↗
PubMed1996

Biomaterials for primary closure of a choledochotomy in dogs.

Since primary closure of the common bile duct is often not undertaken because of the risks of biliary leakage and peritonitis, we have evaluated feasibility and reliability of closure using biomaterials. In three groups of dogs, an unsutured choledochotomy was closed with circular glued patches: a scleroprotein patch in 4 dogs and an oxidized, compressed human collagen patch reinforced (n = 6) or not (n = 6) with three stitches. The scleroprotein patch (n = 4) was resorbed too soon, and in 2 dogs the unstitched collagen patches became unglued; biliary leakage was the result in both instances. The bile duct healed successfully within 1 month in the other 10 animals fitted with collagen patches, despite one common bile duct stricture. Safe primary closure of a choledochotomy may be envisioned in humans if the duct suture is protected by this new collagen biomaterial.

Animals↗
PubMed1994

Experimental pancreatic cancer in the rat treated by photodynamic therapy.

Selective histological necrosis of experimental pancreatic carcinoma by photodynamic therapy (PDT) has been successful with haematoporphyrin derivatives and phthalocyanine as photosensitizers. This report describes the feasibility of PDT with pheophorbide A as the photosensitizer to treat azaserine-induced pancreatic rat carcinoma and analyses survival of the animals. An organ distribution study 24 h after pheophorbide A administration (9 mg/kg intravenously) gave a selectivity ratio of 13.5:1 between tumour and surrounding tissue. Light of 660 nm and 100 J/cm2 induced selective necrosis of the tumour. Six of nine rats were cured in 120 days whereas all 36 control animals died within 35 days (P < 0.01). The pancrease and hepatic pedicle were relatively unaffected by PDT, but the duodenum was injured.

Adenocarcinoma↗
PubMed1994

Implication of cholecystokinin in pancreatic adaptation after biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), a bariatric surgical procedure, leads to a malnutrition-induced general visceral atrophy except for the pancreas. This work investigates the implication of cholecystokinin (CCK) in the exocrine pancreatic adaptive process using a plasma CCK assay and the CCK receptor antagonist CR 1409. No significant reduction in weight and DNA content of the pancreas was noted 36 days after BPB, while a strong decrease in protein, enzymes and RNA contents indicating cellular hypotrophy became apparent. CR 1409 treatment strongly depressed pancreatic weight and its DNA content in BPB animals, suggesting an additional hypoplasia; however, the reduction in pancreatic enzyme content was not aggravated. BPB increased plasma CCK concentrations by 160%, unrelated to CR 1409 treatment. These results indicate that: (1) CCK is involved in the pancreatic adaptive response after BPB in rats, and (2) in the context of a protein malnutrition state, CCK dissociates its pancreatic growth and enzymatic effects, favouring the former.

Adaptation, Physiological↗
PubMed1994

MRI in cerebral venous thrombosis.

Fifty-three patients with cerebral venous thrombosis (CVT) were explored by MRI. Three types of signal abnormalities were observed in thrombosed sinuses: 1) isosignal on T1-weighted sequence and low-intensity signal on T2-weighted sequence (early stage); 2) high-intensity signal on T1-and T2-weighted sequences (intermediate stage); 3) isosignal on T1-weighted sequence and high-intensity signal on T2-weighted sequence (late stage). Signal abnormalities in dural sinuses enabling CVT to be diagnosed were absent in 2 out of 53 cases. Twenty-six out of 53 patients had venous infarction. These lesions were haemorrhagic in 20 cases. MRI made it possible to follow the course of CVT in 15 cases, showing partial or complete recanalization of the occluded sinuses in 14 cases. Our study confirmed that MRI is an excellent non-invasive method to explore CVT. It diagnoses the venous thrombosis, studies parenchymal lesions and follows the course of CVT under treatment. However, MRI is less sensitive than arteriography, particularly in cases of CVT involving only the cortical veins.

Adolescent↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗
PubMed1993

Intra-abdominal photodynamic therapy: from theory to feasibility.

Photodynamic therapy is a new anticancer technique, directed at the selective destruction of neoplastic tissue, which has been used in the treatment of superficial or intraluminal lesions. The technique has now reached the stage where it can be considered in the peroperative management of gastrointestinal tumours, for example in an attempt to eradicate micrometastases in the tissue around the primary tumour or in residual lymph nodes after curative resection. Many practical problems remain to be solved, such as the pharmacokinetics of photosensitizers, the dosimetry of illumination and the sensitivity of intra-abdominal organs. An experimental and clinical evaluation is in progress to assess the feasibility of photodynamic therapy in surgical practice.

Abdominal Neoplasms↗
PubMed1993

Trophic and enzymatic adaptation of the intestine to biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), the exclusion of a duodenojejunal loop from the digestive continuity, has been proposed as a bariatric procedure for treatment of morbid obesity. The present study in rats investigated the effect of this surgical procedure on the mucosae of the ileum directly anastomosed to the stomach, and of the jejunum irrigated only by biliopancreatic secretions. The proximal part of the ileum adapted by two-fold increases in its mucosal mass, total protein and RNA content; DNA content was four-fold higher than in sham-operated animals. There was a correlated increase of mucosal enzyme content, except for lactase. In the distal ileal mucosae, a slight, transient augmentation of mucosal mass, protein, DNA and RNA content was observed which tended to compensate for the shortening of the functional gut. No morphological changes were found in the excluded loop, probably because of an endoluminal stimulation by biliopancreatic secretions. Thus, in BPB, biliopancreatic secretions seem to exert trophic effects on the intestinal mucosa, but they are less potent than the endoluminal nutrition that restores the oral-aboral mucosal gradient.

Adaptation, Physiological↗
PubMed1993

[Laparoscopic surgery: a new alternative to abdominal surgery in renal insufficiency treated by CAPD].

Six laparoscopic abdominal operations were performed in five patients with chronic renal failure with continuous ambulatory peritoneal dialysis. Coelioscopic exploration and operation disclosed several advantages including peritoneal dialysis catheter salvage, abdominal exploration in peritonitis or before catheter implantation, early dialysis after surgery, hence avoiding the need for transient hemodialysis. Furthermore, laparoscopy was reported to decrease postoperative pain and ventilatory disorders. This minimal invasive surgical technique allows rapid recovery of social and professional activities.

Abdomen↗
PubMed1993

[Severe complications after cholecystectomy by celioscopy: lessons from yesterday and today].

The case of a series of grave complications after a laparoscopic cholecystectomy is reported: a common bile duct section diagnosed rather late, hemoperitoneum, inappropriate common bile duct reconstruction and late anastomic leakage, stenosis of an hepatico-jejunal anastomosis, haemorrhage through the external biliary drainage and iterating sepsis. The final outcome was good. The stenotic hepatico-jejunal anastomosis was dilated by a Gianturco self-expanding prosthesis percutaneously placed. As an evidence, this alternative treatment is only exceptional, the treatment of choice for postsurgical benign strictures being surgical repair.

Anastomosis, Surgical↗
PubMed1993

[Boerhaave syndrome or spontaneous rupture of the esophagus].

Spontaneous rupture of esophagus is a rare affection resulting from barotrauma to lower esophagus during the effort of vomiting. The diagnosis is suggested by the presence of violent retrosternal pain after a bout of vomiting following the partaking of a copious meal by an alcoholic patient. Prognosis is dependent on the rapidity of treatment, always surgical and completed by long-term antibiotic therapy. Complementary examinations should be limited to a standard chest x ray and esophageal imaging with water-soluble contrast. Recovery is now the rule for patients treated within 24 hours. Mortality is high in patients diagnosed at a late stage, but this could be reduced by improved recognition of the syndrome.

Adult↗