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S Houry

Publications and source records attributed to S Houry.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Detection of hepatic metastasis of digestive cancers. Value of enzyme assays and ultrasonography].

Alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH) and aspartate aminotransferase (AsT) assays, as well as ultrasonography are the easiest and least expensive examinations to perform in the diagnosis of hepatic metastases. The 273 patients included in this series had cancer of the digestive tract. The diagnosis of presence or absence of liver metastases was made at surgery and was positive in 38 patients (14 per cent). A receiver operating characteristic (ROC) curve was drawn after computing the sensitivity (Se) and specificity (Sp) of each laboratory determination while the threshold indicating that the value was normal was incremented. The examinations were then compared in terms of Se, Sp, positive predictive value and negative predictive value. The threshold was determined on the ROC curve where less false-positive and more true-positive results were shown. According to predictive values, laboratory determinations could be classified in decreasing order of usefulness as: AP, LDH, GGT and AsT. Ultrasonography had a positive predictive value of 68 per cent a negative predictive value of 95 per cent, both figures being higher than those of any laboratory examination. These results suggest that ultrasonography has a higher diagnostic value than any of the enzyme assays in the detection of hepatic metastases. Moreover, ultrasonography provides morphological information which, in case of liver resection, may be useful to the surgeon.

Alkaline Phosphatase↗
PubMed1989

[Peroperative radiotherapy in tumors of the pancreas].

Intraoperative irradiation has been devised as a method to safely deliver higher radiation doses to the tumors while minimizing the dose to the surrounding normal tissues. Among 14 patients treated by intraoperative radiotherapy in our institution, 8 had a pancreatic carcinoma (unresected in 7 patients, and partially resected in 1 patient). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operative room to the basement accelerator suite. A single dose of 15 to 20 Gy with 20meV electrons was delivered. Five patients with a carcinoma of the head of the pancreas had had a biliary and a digestive by-pass. After surgery all the patients received an additional 40 Gy and chemotherapy with 5-Fluorouracil. There was nor post-operative mortality neither morbidity. Four patients with preoperative pain had no pain after treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months. Because of the short follow-up and the small number of patients no conclusion on survival may be made. Nevertheless, in other experiences good palliation has been generally obtained. Significant difference in survival time was noticed in a Japanese experience in unresected cases. In 16 patients with resected carcinomas a 41% survival rate at 2 years has been observed in a North American experience. Thus we are encouraged to continue this approach.

Aged↗
PubMed1989

Gallbladder carcinoma: role of radiation therapy.

Gallbladder carcinoma continues to be a discouraging disease. Prognosis after resection still remains poor. Radiation therapy has been used in an attempt to improve the prognosis but only a few series of less than ten cases have been reported. Since 1977 we have treated 20 patients with gallbladder carcinoma with postoperative radiotherapy (mean total dose 4200 radiation absorbed dose). In four patients all the tumour was resected with the intent of cure. In 12 patients, the lesion was partially resected and in four patients no resection was performed. Seven patients in whom the tumour was partially resected or not resected also had chemotherapy. Our evaluation was retrospective and we compared our results with historical control groups comparable with respect to surgical procedures and pathological staging. In patients operated on for cure, one patient is alive at 84 months, the others died at 7, 8 and 33 months. In patients in whom the tumour was partially resected the mean survival time was 8.1 months and two patients are still alive 7.0 months after treatment. According to the Nevin classification the mean survival time in stage IV and V patients was respectively 9.2 and 7.2 months. There was no difference in survival between patients treated or not treated with chemotherapy. This experience is the largest published and suggests that radiotherapy may increase survival after no resection or palliative resection of gallbladder carcinoma.

Adenocarcinoma↗
PubMed1989

A longitudinal study of histologic and immunohistologic changes in an experimental model of sclerosing cholangitis.

A longitudinal study of intra and extrahepatic bile duct injuries was performed in an animal model of secondary sclerosing cholangitis induced by formalin injection into the common bile duct. Lymphocytic infiltration inside and around the bile ducts occurred seven days after injection. The disease later evolved to a fibrous cholangitis of the small bile ducts. Septal intrahepatic and extrahepatic bile duct involvement became evident three months after formalin injection. The ductular proliferation led to a progressive biliary cirrhosis with portal to portal fibrous septa. After formalin injection, bile duct cells expressed the Ia antigen in the cytoplasm and/or on the membrane of bile duct cells. The intensity of staining did not correlate with the duration or severity of the disease. Lymphocytes infiltrating into and around the bile duct were mainly T-cells. This study suggests that a local cell-mediated immune response to the injection of a toxic agent induces pathological features similar to those of sclerosing cholangitis in man.

Animals↗
PubMed1989

Portal versus peripheral venous drainage in segmental pancreatic transplantation in diabetic rats.

The effect of the site of venous drainage in segmental pancreatic transplantation was investigated in diabetic rats with two surgical procedures anastomosing the superior mesenteric vein either on the vena cava (systemic drainage) or on the superior mesenteric vein (portal drainage). Both procedures corrected polyuria, glycosuria, and blood glucose concentration, and resulted in similar peripheral hyperinsulinemia. Intravenous glucose tolerance tests were performed 8 weeks after transplantation. In portal-grafted rats, glucose tolerance was strictly normalized, with a plasma insulin profile similar to that observed in normal rats. In caval-grafted rats, a delayed plasma insulin peak was observed with slight abnormalities in the plasma glucose profile, the late plasma glucose concentrations being higher than in portal-grafted animals. The extent of fibrosis was similar under both conditions. This study, performed in rats, of the influence of venous drainage on the metabolic outcome of segmental transplantation, demonstrating an abnormal plasma insulin profile during a glucose challenge in case of caval drainage, is consistent with other studies suggesting that the site of drainage might be important in case of reduced grafted mass.

Animals↗
PubMed1989

[Prognosis of surgically treated colorectal neoplasms. Contribution of multivariate analysis].

Dukes' classification is the most usually used method of staging in colorectal carcinoma. However the pitfalls of this classification may be attested by the multitude of modifications of Dukes' staging during the last sixty years. The aim of our study was to evaluate the influence of 25 variables on survival in colorectal carcinoma using the Cox model. This study was performed in 321 patients operated on for colorectal carcinoma. In the 252 patients who had had a curative resection univariate analysis showed that survival was related to 6 variables: age, juxtatumoral lymph node involvement, an abdominal mass, complicated carcinoma, duration of symptoms, and depth of tumor penetration. Stepwise analysis showed the independent influence of 7 variables on survival: age, lymph node involvement, depth of tumor penetration, duration of symptoms, direct spread, preexisting deficiencies, and sex. A byproduct of the regression coefficient of Cox' model was a numerical value for each of these predictive factors. A single composite score was obtained by adding the individual scores of factors from which a prediction of outcome can be made. Applying this model to each of the 252 patients resected for cure, we established three prognostic groups. They predict survival more accurately than the Dukes' system. Our scoring system based on multivariate analysis must successfully defined prognostic groups of patients in other series. Then, it should be recommended for staging in curative resection for colorectal carcinoma.

Aged↗
PubMed1987

[Peroperative radiotherapy in cancer of the pancreas].

Intra-operative irradiation has been devised as a method to safely deliver higher radiation doses to the tumors while minimizing the dose to the surrounding normal tissues. Among 12 patients treated by intraoperative radiotherapy in our institution, 7 had a pancreatic carcinoma (unresected in 6 patients, and partially resected in 1). Anesthetized patients were transferred with the incision temporarily closed from the fourth floor operating theatre to the basement accelerator suite. A single dose of 15 to 20 Gy with 20 MeV electrons was delivered. Five of these patients with carcinoma of the head of the pancreas then had a biliary and a digestive bypass. After surgery, all patients received an additional 40 Gy and chemotherapy with 5-fluorouracil. There was neither post-operative mortality nor morbidity. Three patients with pre-operative pain had no pain following treatment. Five patients died after 5 to 10 months and two patients are alive with a follow-up of 4 and 9 months respectively. Because of the short follow-up and small number of patients, no conclusions concerning survival can be drawn. Nevertheless, in other experiences good palliative results have generally been obtained. Significant differences in survival time were noted in a japanese experience of unresected cases. In 16 patients with resected carcinoma a 41% survival rate at 2 years has been observed in 1 North American study. These results suggest that intra-operative irradiation is worth further trials.

Aged↗
PubMed1987

Human basophil degranulation test in liver hydatidosis.

Upon exposure to a specific antigen, granulation of basophils bearing IgE disappears. The aim of this study was to assess the human basophil degranulation (HBD) test with hydatic antigen in 100 patients. Seventy patients were clinically suspected of having liver hydatidosis (LH) (group I). Eight patients had asymptomatic hepatic calcifications. Twenty-two patients had previous surgery for LH (group III). In group I the percentage of HBD was significantly higher in patients with LH (23 of 70) than in patients with other hepatobiliary diseases (P less than 0.001). In group II all patients had negative HBD tests. In group III the test became negative within 8-12 months after radical surgery in four patients, and remained positive in the other 18. These results suggest that the HBD test is useful for the diagnosis of LH. In asymptomatic patients with hepatic calcified cyst, a negative HBD test suggests a dead parasite. In previously operated patients, a positive test suggests persistence of antigen.

Animals↗
PubMed1987

Treatment of rectal prolapse by Delorme's operation.

Rectopexy in the sacral hollow or to the promontory with synthetic material is the most efficient method of reducing and fixing a complete rectal prolapse. However, this distressing condition occurs frequently in elderly patients, often with high operative risk. In these some surgeons have advocated a perineal approach. Eighteen female patients (mean age 74 years) with complete rectal prolapse have been treated by a modified Delorme's procedure which involves a mucosal stripping of the prolapse and longitudinal plication of the muscular wall of the rectum. There was no postoperative mortality or morbidity. After a mean follow-up of 18 months, two complete recurrences occurred. These were treated by the same technique with a good result at 3 years. One other patient presented a partial and intermittent recurrence. Incontinence has improved in four patients and was not made worse in the others. Our results and those previously published show that this procedure is safe in elderly high risk patients considered too unfit for transabdominal surgery.

Aged↗
PubMed1987

[Peroperative radiotherapy in cancer of the pancreas].

7 patients presenting with unresected (6 cases) or resected (1 case) cancer of the pancreas were treated peroperatively by radiotherapy. Tumors were treated with 15 to 20 Gy delivered by a particle accelerator. There were no post-operative complications. Three patients who were experiencing pain before radiotherapy no longer had pain after radiotherapy and this effect was maintained. Five patients died during the follow-up period after 5 to 10 months. Two patients are still alive after 4 and 9 months' follow-up. This experience with peroperative radiotherapy should be continued.

Aged↗
PubMed1986

[Biliary cysts of the liver].

Biliary cysts of the liver do not communicate with the biliary tract. Eight of the 10 patients operated on were asymptomatic. The cysts were 3 to 30 cm in diameter. In 1 patient, ultrasonically guided drainage of the cyst was followed by recurrence of the lesion and pain. In another patient, a cholangiocarcinoma was discovered in the wall of the cyst. After resection of the protruding part of the cyst the pathological disorders subsided in all patients who were followed up for 6 months to 16 years.

Adult↗
PubMed1986

Caustic sclerosing cholangitis. A complication of the surgical treatment of hydatid disease of the liver.

In five patients, sclerosing cholangitis developed after the surgical treatment of hydatid cyst of the liver. The cyst communicated with the biliary tree, and a scolicidal solution (2% formaldehyde in two patients and 20% sodium chloride in three) was injected into the cyst. Cholangiography showed strictures affecting the intrahepatic biliary tree in two and both the intrahepatic and extrahepatic biliary tree in three. Sclerosing cholangitis in these patients was likely to result from the caustic effect of the scolicidal solution having diffused from the cyst into the biliary tree. We propose to designate this entity "caustic sclerosing cholangitis". Because of the risk of this complication, and the unproved efficacy of intracystic injection of a scolicidal solution in preventing the dissemination of the parasite, we recommend that this maneuver be abandoned in the surgical treatment of hydatid disease of the liver.

Adult↗
PubMed1986

Treatment of local recurrence after primary restorative resection or Hartmann's operation for carcinoma of the colon and the rectum.

Between 1970 and 1985, 20 patients underwent laparotomy for local recurrence following a restorative resection or Hartmann's operation for carcinoma of the colon and rectum. Histological confirmation was made in 18 cases and in 2, recurrence not confirmed at surgery became apparent during subsequent follow-up. Of the 16 patients in whom the site of local recurrence could be defined, there was involvement of the previous anastomosis in 13. At laparotomy 7 patients had disseminated disease and in 5 patients without dissemination, local disease was unresectable. Ten recurrences were amenable to resection. Of these 8 patients had a curative operation with a median survival of 26 months and a 5-year actuarial survival rate of 50%. In 10 patients no resection was performed. Median survival in this group was 5 months but 1 patient is still alive at 10 years after radiotherapy. The results emphasise the importance of follow-up given the high salvage rate in patients in whom a curative resection was possible.

Adult↗