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Y Panis

Publications and source records attributed to Y Panis.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Current findings on gastrointestinal stromal tumors: seven observations of malignant tumors].

PURPOSE: Gastrointestinal stromal tumors (GIST) are rare neoplasms, 1-3% of malignant gastrointestinal tumors. They are immature proliferations of spindled and/or epithelioid cells, developed in the muscular layer of the digestive tract, showing uncompleted or partial muscular, nervous or mixed differentiation. Immunohistologic knowledge about these tumors has recently progressed because of the discovery of specific markers (coexpression vimentin-CD117, oncogenes): GIST can now be distinguished from the other mesenchymal tumors. METHODS: Retrospective study of seven patients with GIST who received the same treatment. RESULTS: For our seven patients the mean age was 49 years with a male predominance (sex-ratio 4/3). The tumoral localisations are principally the small bowel (four cases), the rectum (two cases) and the stomach (one case). The treatment consisted of a first surgery, adapted to the tumoral localisation and extension, associated to chemotherapy in case of metastasis or local recurrence. The study of the histological grading for the seven patients showed tumors with poor prognoses. Six patients developed recurrence in a 2-year period; for the survey we are too close for a proper view. CONCLUSIONS: A review of the literature on stromal tumors finds older patients (59 years) with an equal sex ratio. Against the results of our series, the most frequent location is the stomach (50%). But the main problem is the better understanding of the particular evolution of these tumors. The bad short-date prognosis imposes carrying out larger studies, in order to confirm the principal hypothesis of histogenesis and to improve the survey by an optimal treatment.

Adult↗
PubMed2002

Fate of the rectum in patients undergoing total colectomy for Crohn's disease.

BACKGROUND: This study aimed to analyse disease recurrence and fate of the rectum in patients who had a total colectomy for Crohn's disease. METHODS: One hundred and forty-four patients who had a total colectomy for Crohn's colitis were reviewed retrospectively. Ileorectal anastomosis (IRA) was performed in 118 patients, while 26 never had an IRA after colectomy because of severe anorectal lesions. Factors associated with recurrence and rectal preservation failure were studied. RESULTS: The probability of clinical recurrence after IRA was 58 and 83 per cent at 5 and 10 years respectively. The probability of rectal preservation at 5 and 10 years was 70 and 63 per cent after colectomy, and 86 and 86 per cent after IRA, respectively. Patients with extraintestinal manifestation had a higher risk of recurrence and of rectal preservation failure. Previous ileal involvement was associated with a higher rate of ileal recurrence after IRA. After IRA, prophylactic treatment with 5-aminosalicylic acid was associated with a lower rate of recurrence and of failure to preserve the rectum. CONCLUSION: Overall, 63 per cent of patients had a functioning IRA 10 years after total colectomy. Absence of extraintestinal manifestation and prophylactic treatment with 5-aminosalicylates after IRA were the main factors associated with long-term rectal preservation.

Adolescent↗
PubMed2002

Apigenin--strong cytostatic and anti-angiogenic action in vitro contrasted by lack of efficacy in vivo.

The cancer chemopreventive agent apigenin also has strong cytostatic and anti-angiogenic effects in vitro. We now investigated its efficacy against experimental Lewis lung carcinomas (LLC), C-6 gliomas and DHDK 12 colonic cancers in vivo. Tumour bearing mice received 50 mg/kg/day apigenin in three different galenical formulations during 12 days in 8-hourly intervals. Only weak effects of apigenin on the size and the number of new tumour blood vessels of both established and newly transplanted tumours were recorded although the intratumoural necrosis was elevated (45 +/- 15% vs. 20 +/- 7% (control), p < 0.05%). These results contrast sharply with the high in vitro sensitivity of LLC, C-6, DHDK 12 and endothelial cells to apigenin where complete growth suppression occurs at concentrations beyond 30 g/ml. Possible causes are discussed.

Animals↗
PubMed2001

Impact on survival of surgery after concomitant chemoradiotherapy for locally advanced cancers of the esophagus.

BACKGROUND: To evaluate the results of chemoradiotherapy with or without surgery in locally-advanced esophageal carcinomas (T3 and/or nodal involvement). METHODS: One hundred twelve patients with locally-advanced carcinoma of the esophagus without histologically proven invasion of the tracheobronchial tree or distant visceral metastases were treated with concomitant chemoradiotherapy followed by re-evaluation; surgery was performed or chemoradiotherapy continued, based on tumor regression and the patient's general status. Chemoradiotherapy consisted of concomitant 5-fluorouracil (5FU)(1 g/m(2) day 1-3), cisplatinum (50 mg/m(2) day 1 and 2), and external beam irradiation up to a dose of 40 or 43.2 Gy. After a 4-week rest period, radical esophagectomy or a new cycle of chemoradiotherapy (up to a total dose of 65 Gy) was performed. RESULTS: A complete clinical response was obtained in 25.7% of the patients and a partial response in 45.9%. Fifty patients underwent surgery, but only 38 patients had an esophagectomy. Post-esophagectomy mortality was 5.3%. A complete histologic response rate of 23.7% was obtained. Two- and 5-year survival rates were, respectively, 41.5% and 28.6% for the whole population. According to multivariate analysis, prognostic factors for survival were Karnofsky index, esophagectomy, and response to chemoradiotherapy. Five-year survival for patients who experienced a partial response to radiation and chemotherapy was 49.1% for those who had surgery and 23.5% for those treated without surgery (p = 0.003). There was no obvious benefit for the small number of patients treated surgically after complete response to radiation and chemotherapy. Toxicity, essentially hematologic, was moderate. CONCLUSION: For locally-advanced esophageal carcinomas, esophagectomy, after concomitant chemoradiotherapy, could improve the survival rate, especially for patients who responded partially to the latter.

Adult↗
PubMed2001

Identifying patients with T3-T4 node-negative colon cancer at high risk of recurrence.

PURPOSE: Adjuvant chemotherapy is effective for node-positive colon cancer patients. In node-negative patients, it could be justified in high-risk patients. The purpose of this study was to determine clinical and pathological findings associated with tumor recurrence in T3-T4 node-negative colon cancer patients. METHODS: From 1974 to 1993, 108 patients undergoing colectomy for T3-4N0M0 colon cancer, without adjuvant chemotherapy, followed until death or for a minimum of five years, were divided into two groups: patients without recurrence (n = 74) and those dead from colon cancer or alive with recurrence (n = 34). Thirty-three clinical and pathological findings were studied. RESULTS: In univariate analysis, the following were significantly associated with a high risk of tumor recurrence: male patients (P = 0.006), bowel obstruction (P < 0.001), weight loss >5 Kg (P = 0.03), circumferential tumor (P = 0.02), macroscopic or microscopic pericolic organ invasion (T4 stage; P < 0.001), perineural invasion (P = 0.02), vascular invasion (P = 0.045), poor tumor differentiation (P = 0.005), mesocolic invasion >1 cm (P = 0.009), less than 14 uninvolved nodes on the specimen (P = 0.03), and visceral peritoneal invasion (T4; P < 0.001). In multivariate analysis, the following were independent prognostic factors of recurrence: male patients (P = 0.005), bowel obstruction (P = 0.002), pericolic organ invasion (i.e., T4 tumor; P = 0.02), and less than 14 uninvolved nodes on a specimen (P = 0.01). On the other hand, preoperative carcinoembryonic antigen serum level, size and tumor location, blood transfusion, and mucin production were not associated with higher risk of tumor recurrence. CONCLUSION: Our study identifies a subgroup of patients with node-negative colon cancer at high risk of recurrence, who could be included in priority trials of adjuvant chemotherapy.

Adult↗
PubMed2001

Long-term results of ileal pouch-anal anastomosis for colorectal Crohn's disease.

INTRODUCTION: The aim of this study is to report ten-year results of ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease for whom coloproctectomy and definitive end ileostomy was the only alternative. METHODS: 41 patients (22 females/19 males) with a mean age of 36 +/- 13 (range, 16-72) years underwent ileal pouch-anal anastomosis for colorectal Crohn's disease between 1985 to 1998. None had past or present history of anal manifestations or evidence of small-bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resected specimen after ileal pouch-anal anastomosis, or after occurrence of Crohn's disease-related complication in 15 patients. RESULTS: Follow-up was 113 +/- 37 months, (18-174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients experienced Crohn's disease-related complications, 47 +/- 34 months (8-101) after ileal pouch-anal anastomosis: 2 had persistent anal ulcerations with pouchitis and granulomas on pouch biopsy and were treated medically; 2 experienced extrasphincteric abscesses and 7 presented pouch-perineal fistulas which were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end-ileostomy. Of the 20 patients followed for more than 10 years, 7 (35 percent) experienced Crohn's disease-related complications which required pouch excision in 2 (10 percent). CONCLUSIONS: Ten years after ileal pouch-anal anastomosis for colorectal Crohn's disease, rates of Crohn's disease-related complications and pouch excision were 35 and 10 percent, respectively. These good long-term results justify for us to propose ileal pouch-anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal manifestations and no evidence of small-bowel involvement) for whom the only alternative is definitive end ileostomy.

Adolescent↗
PubMed2001

Handsewn ileal pouch-anal anastomosis on the dentate line after total proctectomy: technique to avoid incomplete mucosectomy and the need for long-term follow-up of the anal transition zone.

PURPOSE: During ileal pouch-anal anastomosis, both conservation of the anal transitional zone during the stapled technique and incomplete mucosectomy in the standard Park's procedure may expose the patient to disease recurrence. We propose here an technique whose aim is to solve both problems by performing handsewn ileal pouch-anal anastomosis on the dentate line after rectal eversion and total proctectomy. METHODS: We reviewed the records of 172 consecutive patients who had undergone ileal pouch-anal anastomosis since 1984 for chronic ulcerative colitis (n = 80), familial adenomatous polyposis (n = 48), selected cases of Crohn's disease (n = 42), or other causes (n = 2). RESULTS: One patient (0.5 percent) died postoperatively. Operative morbidity was similar to that reported after the Park's and stapled procedures. Of our 128 patients with a five-year follow-up, anastomotic stricture occurred in 15 (12 percent), and 4 patients (3 percent) had to have pouch removal. Stool frequency per 24 hours was 4.8 +/- 1.6 (range, 1-11), continence was perfect in 104 patients (81 percent), and sexual activity was estimated to be unchanged in 120 (94 percent). No evidence of disease recurrence was noted in the patients with familial adenomatous polyposis or ulcerative colitis. CONCLUSIONS: During ileal pouch-anal anastomosis, Park's procedure carries the risk of incomplete mucosectomy and disease recurrence, and the stapled procedure requires a long-term follow-up of the anal transitional zone. Our alternative technique with total proctectomy avoids both problems and gives similar long-term functional results.

Adenomatous Polyposis Coli↗
PubMed2001

Operative and long term results after surgery for chronic radiation enteritis.

BACKGROUND: About one third of patients with chronic radiation enteritis will need to be operated on during follow-up. Morbidity and life expectancy after resection and conservative surgical management for chronic radiation enteritis have not been well documented. METHODS: From 1984 to 1994, 109 patients were operated on with a mean follow-up of 40 months (range 1 to 293). Postoperative mortality, early and late morbidity, long-term survival were studied in patients after resection (n = 65) and after conservative surgical management (n = 42), and in patients after planned or emergency procedure. Existence of possible risk factors for reoperation after a first surgical procedure was analyzed. RESULTS: Five (5%) patients died in the postoperative course. Operative mortality was significantly higher when the procedure was performed as an emergency (P <0.05). Although not statistically significant, mortality was higher in the resection group (5% versus 0%). Thirty-three (30%) patients experienced postoperative complications including anastomotic leak in 11. Morbidity was not statistically related to the nature of the treatment (ie, conservative versus resection) or to the indication (emergency versus elective). During follow-up, reoperation was required in 40% of the patients, because of recurrence of digestive symptoms suggestive of chronic radiation enteritis; the reoperation rate was higher in the patients of the conservative group (50% versus 34%). Overall survival, after a mean follow-up of 40 months in patients without cancer recurrence was 85% at 1 year and 69% at 5 years after surgery, respectively. Overall survival was influenced by the nature of the treatment with 51% and 71% 5-year survival after conservative and resection treatment, respectively. CONCLUSIONS: Despite high initial mortality and morbidity rates, life expectancy in patients with chronic radiation enteritis without recurrence of their previous neoplastic disease was good. Resection seems to provide a smaller reoperation rate and a better 5-year survival, but a higher postoperative mortality.

Adolescent↗
PubMed2001

Serial computed tomography is rarely necessary in patients with acute pancreatitis: a prospective study in 102 patients.

BACKGROUND: CT has proved to be helpful in patients with acute pancreatitis for differentiating between mild and severe forms. Followup of acute pancreatitis with CT has been advocated but rarely studied. The aim of this study was to determine if late CT performed at day 7 might be helpful in establishing the prognosis or the type of complications, and to select a subgroup of patients in whom CT could be beneficial. STUDY DESIGN: Contrast-enhanced CT was performed at the admission day and 7 days after admission in 102 patients admitted for acute pancreatitis. The extent of pancreatic inflammation was classified according to Balthazar grade, and intrapancreatic necrosis on these examinations was prospectively assessed and compared with clinical and biologic data and with patient outcomes. RESULTS: Among 102 patients, complications developed in 24 (23%). Complications developed in only 8% of patients with Ranson score <2, making routine early CT unnecessary. For the patients with Ranson score <2 and Balthazar grades A and B at day 1 CT, late CT seemed to be useless. Complication was suspected by clinical and biologic tests before day 7 in 22 of 24 complicated patients (92%), suggesting that CT could be proposed only in cases of clinical or biologic deterioration. Late CT was correlated with a complicated course in patients with Balthazar grades D and E or intrapancreatic necrosis >50%. Late CT was predictive of complications in cases of intrapancreatic necrosis enlarging since the first examination. CONCLUSIONS: Our study showed that in acute pancreatitis: 1) there is little justification for systematic early CT, especially in patients with Ranson score <2, and 2) late CT does not need to be performed routinely, but only in cases of clinical or biologic worsening.

Acute Disease↗
PubMed2001

Long-term results of faecal diversion for refractory perianal Crohn's disease.

BACKGROUND AND AIMS: Faecal diversion (FD) for refractory anoperineal Crohn's disease (APCD) is thought to be unsatisfactory with a low overall rate of defunctioning stoma closure. However, only a few patients have so far been reported in the literature. The aim of this study was to reassess the long-term efficiency of FD for APCD. METHODS: Among 136 patients who were operated for APCD over a 18-year period, 17 underwent FD. The factors assessed were the mortality and morbidity of stoma formation, the evolution of anoperineal Crohn's disease after FD, and predictive factors of FD effectiveness. RESULTS: Mean follow-up after FD was 135 +/- 79 months (range 20-328). Initial healing of APCD was observed in 11 patients (65%), allowing stoma closure after 14 +/- 9 months (range 3-52). The 6 other patients underwent abdominoperineal resection (APR) for persistent APCD. Three of the 11 patients with normal bowel continuity underwent secondary APR for APCD recurrence. Thus, at the end of follow up 9 (53%) patients had definitive end ileostomy and 8 (47%) continued to have normal bowel continuity with a mean follow up of 124 +/- 90 months (range 12-292) after stoma closure. The presence of rectal lesions at the time of FD was the only predictive factor of poor outcome: 8/9 (89%) patients with rectal lesions underwent APR vs 1/8 (13%) patients without rectal lesion (P < 0.01). CONCLUSIONS: Faecal diversion for anoperineal Crohn's disease produced a high initial rate of anoperineal lesion healing. After long-term follow-up, results of faecal diversion are good (normal bowel continuity was restored in 89%) in patients without associated rectal lesions. However, in patients with associated rectal lesions, the prospects for restoring continuity were limited, thus making faecal diversion a questionable procedure.

Journal Article↗
PubMed2001

Predictive factors for perioperative blood transfusions in rectal resection for cancer: A multivariate analysis of a group of 212 patients.

BACKGROUND: In colorectal cancer surgery, allogeneic blood transfusions have reportedly been associated with higher rates of postoperative complications and tumor recurrence. However, because of the increased cost of alternative types of blood transfusions (eg, the use of autologous blood or erythropoietin administration), their routine use cannot be recommended. This study evaluated the risk factors for perioperative blood transfusions in resection for rectal cancer in order to identify patients who could benefit from these methods. METHODS: From 1990 to 1997, 212 consecutive patients who underwent elective rectal resection for cancer were reviewed. The associations between perioperative heterologous blood transfusion and 18 patient-, tumor-, surgical-, and treatment-related variables were assessed by univariate and multivariate analysis. RESULTS: Of the 212 patients, 72 (34%) received transfusions. Multivariate analysis revealed that 5 preoperative variables were significant risk factors for perioperative blood transfusion: age > 65 years (P =.03), body mass index > 27 kg/m(2) (P =.04), preoperative hemoglobin < or = 12.5 g/dL (P <.0001), American Society of Anesthesiologists status > 2 (P =.024), and additional surgical procedures (P =.018). In patients with anemia, the risk of transfusion was at least 47% in patients with 1 other risk factor or more. In nonanemic patients, the risk of transfusion was under 11% in patients with 1 risk factor or none, but increased to 47% in those with 2 or more risk factors. CONCLUSIONS: Our analysis of risk factors for perioperative blood transfusion in rectal resection for cancer must be considered to constitute guidelines for a more responsible use of the expensive alternatives to allogeneic blood transfusion.

Aged↗
PubMed2000

[Primary epiploic appendicitis: CT diagnosis for conservative treatment].

OBJECTIVE: Primary epiploic appendicitis is an uncommon, self-limited disease with spontaneous resolution. Diagnosis is usually made at surgery as the disease is generally mistaken for acute appendicitis or sigmoid diverticulitis. CT allows a non-invasive diagnosis, thus avoiding unnecessary surgery. The condition can be managed conservatively with the use of analgesic drugs only, and clinical evolution is uneventful. The aim of this study is to report the CT features of this pathologic process before and after medical treatment by analgesics. PATIENTS AND METHOD: Six patients (4 men and 2 women aged from 23 to 70 year old mean; 29 year old) underwent abdominal CT scan because of acute abdominal pain located in the left lower quadrant (n = 3) and right lower quadrant (n = 3). No patient had fever. Laboratory findings were normal in all cases. Follow-up CT scans were obtained in 4 patients respectively at 2, 4, 8 and 80 weeks. RESULTS: CT scan showed in all cases a fatty mass located to the anterolateral wall of the colon, delineated by an hyper attenuating rim. Infiltration of the pericolic fat was noted in all cases. Follow up CT scans obtained in 4 patients showed that the inflammatory signs had cleared in all cases, the lesion had disappeared (n = 2), decreased in size (n = 1) or a residual paracolic node was observed (n = 1). CONCLUSION: Primary epiploic appendicitis is a rare disease. Knowledge of CT signs allowed the correct diagnosis and a conservative management.

Abdomen, Acute↗
PubMed2000

Mucosal changes in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis.

PURPOSE: Inflammation and dysplasia may affect the ileal pouch after restorative proctocolectomy and ileal pouch-anal anastomosis. The aim of this prospective study was to evaluate the morphologic changes and the risk of dysplasia within the pouch after ileal pouch-anal anastomosis. METHODS: Thirty-seven patients with ileal pouch-anal anastomosis underwent endoscopies and biopsies of the pouch: 21 patients were affected by ulcerative colitis and 16 by Crohn's colitis. The mucosal biopsy specimens were studied to investigate the degree of acute and chronic inflammation and the occurrence of dysplasia. A score system was calculated for each patient and correlated with the histologic diagnosis of ulcerative colitis or Crohn's colitis. RESULTS: After a median follow-up of 85 (range, 7-198) months, the inflammation histologic score evaluated was 3.8 (95 percent confidence interval, 2.4-5.1) and 3.5 (95 percent confidence interval, 2.6-4.3), respectively, in patients with Crohn's colitis and ulcerative colitis (mean and 95 percent confidence interval; P = 0.74, not significant), and no patient developed mucosal dysplasia. Fifteen patients (40.5 percent) developed clinical pouchitis that occurred in Crohn's colitis (9/16 patients or 56 percent) and in ulcerative colitis (6/21 patients or 28 percent; P not significant). The score was 4.1 (95 percent confidence interval, 3.2-5) in patients with pouchitis and 3.2 (95 percent confidence interval, 2.1-4.3) in patients without clinical pouchitis (P = 0.012) and was 4.1 (95 percent confidence interval, 2.6-5.5) and 4 (95 percent confidence interval, 2.9-5.3), respectively, in pouchitis patients with Crohn's colitis and ulcerative colitis. CONCLUSION: No difference in the inflammation histologic score was observed in ileal pouches after restorative proctocolectomy for ulcerative and Crohn's colitis. In our series, which includes those patients with longer follow-up (>5 years) or with chronic unremitting pouchitis, no case of dysplasia was found. The occurrence of pouchitis was higher in the case of ileal pouch-anal anastomosis for Crohn's disease than for ulcerative colitis, but no difference in the severity of the histologic score was noted.

Adult↗
PubMed2000

Impact of obesity on surgical outcomes after colorectal resection.

BACKGROUND: As the impact of obesity on surgical outcomes after colorectal resection is not well known, this study was designed to compare the results of colorectal resection in obese and nonobese patients. METHODS: From 1990 to 1997, 584 consecutive patients underwent elective colorectal resection in our department. Of these, 158 (27%) were obese (body mass index >27). Obese and nonobese patients were well matched for demographic data and surgical procedures. RESULTS: After right or left colectomy, no difference was noted between obese and nonobese patients for overall mortality, morbidity, or leakage rates. However, after left colectomy, postoperative intra-abdominal collections requiring treatment were significantly more frequent in obese than in nonobese patients (10% versus 2%; P <0.05). After proctectomy, the mortality rate was 5% (3 of 61) among obese patients and 0.5% (1 of 185) among nonobese patients (P <0.02). The anastomotic leakage rate was 16% (5 of 58) for obese patients and 6% (11 of 169) for nonobese patients (P <0. 05), and the corresponding proportions of transfused patients were 43% and 19%, respectively (P <0.02). After proctectomy, multivariate analysis showed that for obese patients, diabetes mellitus (P <0.05) and American Society of Anesthesiologists (ASA) status >2 (P <0.05) were significant risk factors for anastomotic leakage; age >60 years (P <0.01) and ASA status >2 (P <0.05) were significant risk factors for perioperative blood transfusions. CONCLUSIONS: Our study suggested that, for obese patients, (1) right colectomy can be performed in the same manner as for nonobese patients; (2) after left colectomy, abdominal drainage may be indicated, and (3) after proctectomy, a defunctioning stoma should be recommended when diabetes mellitus or ASA status >2 is present, and an autologous blood transfusion could be discussed for patients >60 years old or with ASA status >2.

Aged↗
PubMed2000

Intraoperative enteroscopy for diagnosis and management of unexplained gastrointestinal bleeding.

BACKGROUND: The aim of this study was to evaluate the diagnostic and therapeutic yield of intraoperative enteroscopy in patients with obscure gastrointestinal (GI) bleeding. METHODS: Complete intraoperative enteroscopy was performed in 25 patients with GI bleeding (overt hemorrhage 21, occult blood loss 4). The cause of GI bleeding was unknown before intraoperative enteroscopy in 20 patients and presumed in 5 (colon 4, duodenum 1). RESULTS: Complete inspection of the small bowel was achieved in all cases. Mucosal-based lesions of the small bowel were identified in 16 of the 20 patients in whom the source of bleeding was unknown preoperatively (angiodysplasia 12, other causes 4). These lesions were treated by segmental small bowel resection (15) or medical therapy (1). With a mean 19-month follow-up, the rebleeding rate was 30% (6 of 20), and 2 of them in whom enteroscopy was negative died of massive hemorrhage. Intraoperative enteroscopy was normal in the 5 patients with bleeding of presumed GI origin preoperatively. CONCLUSIONS: Intraoperative enteroscopy remains a valuable tool for exploring obscure GI bleeding in selected patients.

Adult↗