Search PubMed⌕ Search

Biomedical subjects

T Ponchon

Publications and source records attributed to T Ponchon.

At least 91 records · Page 5Linked to original sources
PubMed1990

[The role of lithotripsy in the treatment of common bile duct calculi].

Lithotrity is aimed at breaking up the calculi in the main bile duct in order to facilitate their extraction, especially after endoscopic sphincterotomy (5% of cases). Extracorporeal lithotrity is effective in 90% of cases, but it requires repeated sessions. Intracorporeal lithotrity is advantageous in that it can be performed immediately after endoscopic sphincterotomy, but the material used may cause injuries to the wall of the biliary tract and requires a sophisticated biliary endoscopic system for visual control. Intrahepatic calculi also represent an excellent application of intracorporeal lithotrity, either during surgery or during transhepatic percutaneous drainage.

Gallstones↗
PubMed1989

Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of Vater.

In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.

Adenocarcinoma↗
PubMed1989

Gallstone disappearance after extracorporeal lithotripsy and oral bile acid dissolution.

Extracorporeal shock-wave cholelithotripsy was carried out in 135 symptomatic patients with radiolucent gallstones, followed by oral bile acid dissolution to assess the resultant stone disappearance rates. Fragmentation was satisfactory (all fragments less than 5 mm in diameter) in 34 patients (25%) after a single session of lithotripsy, and in 65 (48%) after multiple sessions. The overall satisfactory fragmentation rate was significantly higher in patients with single stones less than or equal to 20 mm in diameter when compared with those with larger solitary stones (71% vs. 38%, p less than 0.05), as it also was in all subjects with solitary stones when compared with those with multiple stones (60% vs. 34%, p less than 0.05). After 6, 9, and 12 mo of oral bile acid treatment, the stone-free rates were significantly higher in patients with satisfactory than in those with partial fragmentation (55% vs. 0%, 80% vs. 29%, and 90% vs. 33%, respectively; p less than 0.05). Only 1 of the 7 patients who had previously undergone endoscopic sphincterotomy for concomitant choledocholithiasis was free of stones after 1 yr of dissolution. During dissolution therapy, of the 102 patients in whom fragmentation had occurred, 1 (1%) developed mild acute pancreatitis, 23 (23%) suffered attacks of biliary colic, and 6 (6%) required cholecystectomy. We conclude that the result of fragmentation appears to be a major determinant of the success and rapidity of subsequent oral bile acid dissolution, and that when satisfactory, it allows for complete stone disappearance in most patients within the following year. A comparison of the present results with those of previous original studies suggests that to achieve such satisfactory fragmentation, patients should be selected on the basis of their stone characteristics, which optimally should present as solitary gallbladder calculi less than 20 mm in diameter. Furthermore, real-time ultrasonographic monitoring should be used during lithotripsy with a transducer centered along the shock-wave axis. Despite the innocuousness of the shock waves, the incidence of fragment migration and its possible complications, in our experience, emphasizes the need to restrict at present this nonoperative approach to the treatment of symptomatic gallstone disease.

Adult↗
PubMed1989

Biliary lithiasis: combined endoscopic and surgical treatment.

A combined endoscopic and surgical procedure was performed in 69 patients suffering from gallbladder lithiasis with suspected associated lithiasis of the common bile duct (CBD). The procedure was spread over two days: Day 1 - Endoscopic retrograde cholangiopancreatography (ERCP) revealed choledocholithiasis in 50 cases and papillary sclerosis in 4 cases. In 15 patients, the common bile duct was found to be normal. Fifty-four endoscopic sphincterotomies were performed. Among the 50 cases of choledocholithiasis, endoscopic removal of the stones was judged complete in 44 cases and incomplete in the other 6. Day 2 - Cholecystectomy was carried out in all the patients. Peroperative cholangiography confirmed the results of the pre-operative ERCP with respect to the CBD in all the patients except one, and a choledochotomy was necessary in 6 patients. Results were as follows: The average length of hospitalization was 12.4 days. No residual choledocholithiasis was noted. The morbidity of the procedure was 7.2%, and the mortality 1.4% unrelated to the technique. The diagnostic and therapeutic significance of the procedure is discussed.

Adult↗
PubMed1989

Experimental tissue lesions related to extracorporeal lithotripsy of gallbladder.

Eighteen dogs were studied to determine the presence, extent and evolution of tissue lesions related to extracorporeal lithotripsy of the gallbladder under conditions similar to those encountered in clinical practice (electrohydraulic generator, ultrasonographic localization, prone positioning and 2,500 shocks delivered per session). Twelve dogs underwent lithotripsy 14 days after implantation of a 9 to 14 millimeter human stone in the gallbladder. The dogs were sacrificed one, 14 and 28 days after lithotripsy (four dogs at each date). Two dogs underwent implantation of stone but not lithotripsy and were sacrificed 14 days later. The last four dogs received only shock wave therapy and were sacrificed one (two dogs) and 14 (two dogs) days later. All calculi were completely fragmented into pieces less than 5 millimeters. Increases in leukocyte count (11 +/- 3.7 10(9) per liter) and alanine and aspartate aminotransferase levels (206 +/- 139 and 156 +/- 164 international units per deciliter, respectively) were seen after lithotripsy (p less than 0.05), but returned to normal during the next four weeks. Macroscopic hemorrhages were noted only in the dogs having undergone lithotripsy and were exclusively located in the organs lying in the path of the shock wave. Macroscopic hemorrhages were found in all six dogs sacrificed the day after lithotripsy and in two of the six dogs sacrificed 14 days later; one dog of the four sacrificed 28 days after lithotripsy still showed a large hemorrhage in the wall of the gallbladder. Microscopic abnormalities included congestion and hemorrhage of the same organs; although more discrete, congestion and hemorrhage were still present one month after shock wave therapy. Early and localized pulmonary fibrosis at the hypercellular stage was noted in two of the four dogs sacrificed at 28 days. The clinical implications for biliary lithotripsy upon humans include the necessity for intact coagulation parameters, strict avoidance of the bases of the lungs in targeting the stone and performing an ultrasonographic assessment of the wall of the gallbladder before repeating lithotripsy sessions, month apart.

Alanine Transaminase↗
PubMed1988

Laser treatment of tumors of the papilla of Vater.

Tumors of the papilla of Vater, should be separated from periampullary tumors. They are not always malignant, and recent data from endoscopy series, and pathology studies, supports the adenoma-carcinoma sequence at this level. Adenomas are tubular or villous and are classified according to the degree of dysplasia. The endoscopic pattern separates exophytic tumors, sessile and easily detected, from intracanalar tumors usually detected after sphincterotomy. The malignancy of an exophytic tumor is suspected when it is ulcerated or large (over 3 cm), and is easily confirmed by biopsies. The typing of intracanalar tumors is more difficult. In a 5-year period, an ampullary tumor was detected by ERCP in 52 patients: the tumor was exophytic in 33 and intracanalar in 19. Adenocarcinoma was confirmed in 26 and adenoma in 26, resulting in a 50% ratio. Among the adenomas, 18 were fully benign and 8 had a superficial cancer focus. Therapeutic procedures included: laser photodestruction in 16, snare resection in 16, sphincterotomy in 47, stenting in 8, surgical bypass in 7, cephalic duodenopancreatectomy in 16. The 16 patients treated by laser (Nd:YAG mainly) included 8 adenomas: a complete tumor destruction was obtained in 7 (follow up from 14 to 53 months). Adenomatous recurrence was observed at 2 years in one patient. In 8 other patients the tumor was an adenocarcinoma; Laser photodestruction failed to completely destroy the tumor in 1 patient (operative control), in 7 others it was adopted as a complement to sphincteromy and stenting in palliation, but was not found very effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

[Electrohydraulic biliary lithotripsy. What approach?].

In 11 patients stones in the common bile duct or in intrahepatic bile ducts could not be extracted by the retrograde route after endoscopic sphincterotomy. Electro-hydraulic lithotripsy was then attempted, using the retrograde route in 4 cases, the transhepatic route in 3 cases and the extracorporeal shock wave technique in 7 cases. The stones could be divided into fragments small enough to be extracted in all patients. The respective indications of the 3 types of electro-hydraulic biliary lithotripsy are discussed.

Aged↗
PubMed1987

Cystic malformations of the cystic duct.

While cystic malformations of the main biliary tract are wellknown and classified, it is exceptional to find cystic malformations of the accessory biliary tract (cystic duct). An adolescent aged 15 years and an adult of 49 years were operated for cysts of the cystic duct revealed by associated lesions, a cyst of the common bile-duct and gallbladder stones respectively. Ultrasonography showed cystic lesions which opacification during intravenous cholangiography and endoscopic retrograde cholangiography (EPRC) proved to be related to the cystic duct. The radiography outline of the biliary pathways so obtained served as a guide to the operative procedure, consisting of excision of the accessory biliary tract in both cases combined with resection of the common bile-duct cyst in one case. The radiologic, anatomic and histologic findings distinguished the lesions encountered from other malformations of the accessory biliary tract and confirmed their derivation from the cystic duct.

Adolescent↗
PubMed1987

Evaluation of a combined percutaneous-endoscopic procedure for the treatment of choledocholithiasis and benign papillary stenosis.

In 19 patients suffering from choledocholithiasis or papillary stenosis, retrograde cholangiography or sphincterotomy failed because of anatomic abnormalities. In such cases, sphincterotomy was then performed with the assistance of a percutaneous catheter. Two complications were observed: moderate bleeding from the transhepatic drain, and a retroperitoneal perforation needing surgery. This combined procedure is very efficient, but gives rise to complications of both the transhepatic and endoscopic routes.

Aged↗
PubMed1987

Endoscopic retrograde cholangiography and sphincterotomy for complicated hepatic hydatid cyst.

We report on the results of 20 endoscopic cholangiographies indicated for hepatic hydatid disease: 14 for pre-operative investigation and 6 for post-surgical complications. In 4 out of 14 cases, endoscopic retrograde cholangiography (ERC) was not an effective procedure for the pre-operative diagnosis of complicated hepatic hydatid cyst in the biliary tract. Endoscopic sphincterotomy was performed without complications in 9 patients and permitted pre- or post-surgical removal of intrabiliary hydatid fragments in 6, successful treatments of 2 post-surgical external biliary fistulae and in association with transhepatic drainage, improvement of the clinical and biological course of one case of secondary sclerosing cholangitis. Endoscopic sphincterotomy might be indicated not only in the case of ERC diagnosis of complicated hepatic hydatic cyst, but also in the case of isolated cholangitis in patients with hepatic hydatid disease, and for complications of surgical treatment.

Cholangiopancreatography, Endoscopic Retrograde↗