Search PubMed⌕ Search

Biomedical subjects

Y Panis

Publications and source records attributed to Y Panis.

At least 91 records · Page 5Linked to original sources
PubMed1997

Reappraisal of pancreaticojejunostomy after pancreaticoduodenectomy: a report of 86 cases with particular reference to the rate of pancreatic fistulation.

OBJECTIVE: To report our experience of 86 patients who underwent pancreaticoduodenectomy followed by pancreaticojejunostomy, paying particular attention to the rate of fistulation. DESIGN: Retrospective study. SETTING: Two teaching hospitals, France. SUBJECTS: 86 patients (58 men and 28 women) who required pancreatic resection for adenocarcinomas of the head of the pancreas (n = 34), chronic pancreatitis (n = 21), cancer of the ampulla of Vater (n = 12), cancer of the distal bile duct (n = 6), or other causes (n = 13). INTERVENTION: Pancreaticoduodenectomy followed by pancreaticojejunostomy with mucosa to mucosa suture. RESULTS: 26 patients (30%) developed complications, 9 (10%) required reoperation, and 8 (9%) died postoperatively. Pancreatic fistulas developed in 2 (2%), one of whom was successfully treated conservatively. The other was reoperated on and died on day 40. CONCLUSION: Pancreaticojejunostomy after pancreaticoduodenectomy is safe, and the rate of fistulation compares favourably with that after pancreaticogastrostomy (2%).

Adenocarcinoma↗
PubMed1996

Ileal pouch/anal anastomosis for Crohn's disease.

BACKGROUND: Patients with Crohn's disease (CD) are not commonly considered as candidates for ileal pouch/anal anastomosis (IPAA). This approach has been avoided because of the poor results observed, retrospectively, in patients with an initial diagnosis of ulcerative colitis who were found to have CD on examination of the resected specimen. However, in 1985, we decided to investigate an alternative to coloproctectomy with definitive end-ileostomy by a prospective study of IPAA for selected patients with CD. METHODS: Between 1985 and 1992, 31 patients with CD, but with no evidence of anoperineal or small-bowel disease, were recruited to our study. They comprised 15 men and 16 women whose mean age was 36 years (SD 14; range 16-72). All CD patients underwent IPAA. The short-term and long-term functional results of this procedure were compared with those of 71 ulcerative colitis patients who also underwent IPAA during the same period in our unit. Mean follow-up was 59 (SD 25) months. FINDINGS: No significant differences were observed between patients with CD and ulcerative colitis in the postoperative complication rate. Of the 31 CD patients, six (19%) experienced specific complications 9 months to 6 years after surgery: three had pouch-perineal fistulas, which required pouch excision in two cases; one had a pouch-vaginal fistula that was treated by gracilis muscle interposition; and one had an extrasphincteric abscess, which was treated surgically. Two patients (6%), one of whom was treated for an extrasphincteric abscess, experienced CD recurrence on the reservoir, and were treated successfully with azathioprine. At 5-year follow-up, there were no significant differences between patients with CD and ulcerative colitis in stool frequency (5.0 [2.0] vs 4.7 [1.4] per day; p=0.68), continence, gas/stool discrimination, leak or need for protective pads, and sexual activity. INTERPRETATION: Our results show that in selected cases of CD without anoperineal or small-bowel manifestations, IPPA can be recommended as an alternative to coloprotectomy with definitive end-ileostomy, when rectal resection is essential.

Adult↗
PubMed1996

[Surgical treatment of acute pancreatitis].

The aim of surgical treatment in acute pancreatitis is two-fold: 1. pancreatic necrosis excision; 2. suppression of possible cause. Pancreatic surgery is only indicated in acute necrotic pancreatitis with local or systemic complications. Necrosis excision with abdominal drainage has to be confined to patients with refractory systemic disorders despite intensive care management and in case of infected necrosis proved by positive culture of collection obtained under ultrasound or CT-scan. Necrosis excision can sometimes require iteratives laparotomies. Nevertheless, a 25%-hospital mortality rate remains observed in such cases. Surgery is often necessary in cases of pancreatic abcesses and pseudocysts because of the high failure rate of percutaneous treatment. Sometimes, surgery is also required in cases of haemorrhage, intestinal stenosis or perforation, due to the progression of peripancreatic necrosis. Treatment of biliary pancreatitis includes suppression of the biliary cause by cholecystectomy and common bile duct clearance in some cases. The indication of endoscopic sphincterotomy remains to be established.

Acute Disease↗
PubMed1996

High tumor necrosis factor serum level is associated with increased survival in patients with abdominal septic shock: a prospective study in 59 patients.

BACKGROUND: In several studies including patients with septic shock of various origins, high serum cytokine levels have been reported to correlate with poor outcome. The aim of this prospective study was to assess the prognostic value of cytokine serum levels in a group of patients with perioperative septic shock of digestive origin. METHODS: From January 1992 to December 1994, 59 patients were evaluated (mean age, 68 +/- 15 years). From the first day of septic shock to day 7, blood was drawn every day to measure the conventional biologic parameters (white blood cell count, platelet count, hematocrit, blood urea nitrogen level, serum electrolytes level, pH, blood gases, serum lactate level, coagulation parameters, liver function tests) and tumor necrosis factor (TNF), interleukin-1, and interleukin-6. RESULTS: No difference was observed between the 26 survivors and the 33 nonsurvivors with regard to age, gender, and cause of sepsis. On admission, mean platelet count was significantly higher in the survivors than in the nonsurvivors (260 +/- 142 versus 177 +/- 122 10(9)/L; p = 0.01). Mean blood urea nitrogen level was significantly lower in the survivors than in the nonsurvivors (9.6 +/- 9 versus 12 +/- 7 mmol/L; p = 0.04). No difference was observed between survivors and nonsurvivors for the other conventional biologic parameters and for serum interleukin-1 and interleukin-6 levels. Mean serum TNF level tended to be higher in survivors than in nonsurvivors (565 +/- 1325 versus 94 +/- 69 pg/ml; not significant). In the group survivor 9 (35%) of 26 patients had a serum TNF level greater than 200 pg/ml versus 2 (6%) of 33 patients in the nonsurvivor group (p < 0.02). Survival was noted in 6 (100%) of 6 patients who had both a serum TNF level greater than 200 pg/ml and a platelet count greater than 100.10(9)/L versus 1 (11%) of 9 in patients with neither of these criteria (p < 0.01). CONCLUSIONS: In our patients with abdominal septic shock, high serum TNF levels were associated with increased survival. The high serum level of TNF may reflect the efficacy of peritoneal inflammatory response against abdominal sepsis. Although this possibility must be further explored, a score combining the serum TNF level and platelet count could be helpful for the prognostic assessment of patients with abdominal septic shock.

Abdomen↗
PubMed1996

Coloanal anastomosis for benign lesions: long term functional results in 11 patients.

OBJECTIVE: To assess the indications, morbidity, and long-term functional results of rectal resection and coloanal anastomosis for benign rectal lesions. DESIGN: Retrospective study. SETTING: Teaching hospital, France. SUBJECTS AND INTERVENTIONS: Eleven patients were operated on for villous adenoma (n = 5), radiation proctitis (n = 2), solitary rectal ulcer (n = 2), rectal stenosis (n = 1) and rectovaginal fistula (n = 1). MAIN OUTCOMES MEASURES: Morbidity, mortality, and long-term results. RESULTS: There were no postoperative deaths. 2 patients (18%) developed major postoperative complications: one pelvic abscess was treated conservatively and one anastomotic fistula required a diverting colostomy. The mean (SD) follow-up period was 89 (35) months. Functional results were judged as perfect (n = 4), good (n = 1), or acceptable (n = 2) (mean stool frequency: 1.4), including the five with villous adenoma, one with radiation proctitis, and the one with a rectovaginal fistula. By the end of the follow-up period, 4 patients (36%) had permanent colostomies (including the two patients with solitary rectal ulcers). Two of them were required soon after operation, and two following failure 5 and 2 years later, respectively, after initially good functional results. CONCLUSION: Rectal resection with coloanal anastomosis can safely be proposed for selected patients with benign rectal lesions including diffuse villous adenoma, rectovaginal fistula, and radiation proctitis without deterioration of the anal sphincter. The poor results in the 2 cases of solitary rectal ulcer suggest that for this condition coloanal anastomosis should be done only after the failure of previous surgical treatment.

Adenoma, Villous↗
PubMed1996

Ileal pouch-anal anastomosis with mesorectal excision for rectal cancer complicating familial adenomatous polyposis.

OBJECTIVE: To assess the long term results of ileal pouch-anal anastomosis (IPAA) with mesorectal excision for rectal carcinoma complicating familial adenomatous polyposis (FAP). DESIGN: Retrospective study. SETTING: Teaching hospital, France. SUBJECTS: 6 patients with FAP and associated rectal carcinoma and 87 patients who underwent IPAA for benign disease. MAIN OUTCOMES MEASURES: Morbidity and mortality. RESULTS: There were no postoperative deaths and no significant differences between the groups in postoperative morbidity. Mean follow-up was 35 months. Two patients in the cancer group died 33 and 40 months after IPAA of liver metastases, but had no evidence of local recurrence. There were no recurrences among the other 4 patients. There were no significant differences between the groups in stool frequency, continence, gas/stool discrimination, leak, or need for protective pads. The risk of impotence and retrograde ejaculation was higher (but not significantly) in men with rectal cancer than in those with benign disease (1/4, 25% compared with 1/47, 2%; p = 0.15). CONCLUSION: In cases of rectal carcinoma complicating FAP, IPAA with mesorectal excision should be proposed as an alternative to coloproctectomy with definitive ileostomy. Long term functional evaluation showed that continence and defaecation were similar to those followed up after IPAA for benign disease.

Adenomatous Polyposis Coli↗
PubMed1996

Gene therapy for liver tumors.

Therapeutic gene transfer has progressed quite rapidly in recent years. Noticeably, it has now reached the clinical stage in both fields of inherited and acquired diseases. Numerous studies of liver-targeted gene therapy and cancer gene therapy have supported the hope that such innovative approaches may be of help in the treatment of primary or secondary liver tumors. In this article, the main strategies of experimental, hepatic cancer gene therapy in the prospect of a clinical use are reviewed.

Adenoviridae↗
PubMed1995

[Gene therapy. A new prospect in the treatment of liver tumors].

To be effective, gene therapy requires three essential elements: a gene to transfer, a vector to carry the gene,and a target cell (here the cancer cell). One type of gene action of particular interest is the suicide gene. When introduced into the cell, the expression of this gene leads to cell death by production of pro-drugs. For example the gene for thymidine kinase from the type 1 herpes simplex virus (HSV1-TK) transforms nucleoside analogues such as ganciclovir into triphosphates which inhibit polymerases. When incorporated into deoxyribonucleic acid during cell division, DNA synthesis is arrested causing cell death. Thus only cells containing the HSV1-TK gene are sensitive to ganciclovir. The most widely used vectors are retroviruses. When these vectors infect a cell, the genes they carry are incorporated into the cell genome and, in the case of suicide genes, lead to cell death. These retrovirus vectors must however be transformed by genetic engineering to remove their capacity for replication so that no viral replication occurs, limiting the effect to the infected cell alone. In cancer therapy, retrovirus appears to be a choice vector since only cells undergoing active division, such as malignant tumour cells, are affected by the gene transfer. Primary or secondary liver tumours are a choice target for gene therapy for several reasons. First, cell division in these tumours is permanent and rapid while the surrounding healthy tissue is in a quiescent state. Secondly, gene therapy could be possible in man since extra-hepatic diffusion of the retrovirus could be avoided by temporary exclusion of the hepatic circulation during perfusion of the retrovirus. Although the long-term risks of using retrovirus vectors for gene therapy (effect on germ cells, oncogenesis), the effect on multiple or large tumours of the liver and the proliferative potential of residual tumour cells remain to be determined, gene therapy for liver cancer is now entering the stage where promising clinical applications may soon be proposed. We have applied gene therapy in in vivo experimental animal models with promising results suggesting that liver cancer may be one of the first applications of this new therapeutic tool in man.

Animals↗
PubMed1995

Levels of portal and systemic blood cytokines after colectomy in patients with carcinoma or Crohn's disease.

BACKGROUND: Cytokine overproduction has been observed in different pathophysiologic conditions, including sepsis, carcinoma, inflammatory disease, and tissue injury induced by operation. Colectomy is a procedure that may result in excessive cytokine release through the portal vein. The respective effects of an operative procedure, perioperative septic complications, and of the disease itself on cytokine production are still not known. STUDY DESIGN: This study was done to investigate the variations in the levels of interleukin-1 beta (IL-1), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) in portal and systemic blood during and after colectomy in patients with malignancy or with Crohn's disease. Blood samples were collected intraoperatively from portal and systemic veins of 24 patients undergoing colectomy for either Crohn's disease (n = 13) or carcinoma (n = 11), and postoperatively (from days 1 to 5) from systemic veins. The changes in blood levels of cytokines and CRP in patients with an uneventful colectomy (n = 19) were compared to changes in patients whose colectomy was complicated by sepsis (n = 5). Similar changes in cytokines and CRP levels were compared between patients with malignancy and those with Crohn's disease. RESULTS: The portal and systemic blood levels of IL-1, IL-6, TNF-alpha, and CRP were significantly correlated before and after colectomy. In portal blood, the level of IL-6 was significantly higher after colectomy than before. In systemic blood, the levels of CRP, TNF-alpha, and IL-6 before colectomy were significantly higher in patients with Crohn's disease than in patients with malignancy. After uneventful colectomy, a temporary increase in CRP, TNF-alpha, and IL-6 was noted in systemic blood, followed by a rapid decrease, although systemic blood cytokine levels remained significantly higher after colectomy complicated by sepsis. Interleukin-1 beta levels in both portal and systemic blood remained unchanged during and after colectomy, regardless of the indication for operation and its outcome. CONCLUSIONS: Colectomy causes acute release of cytokines and CRP in both the portal and systemic circulation. The increase in IL-6 observed after colectomy in portal blood and subsequently in systemic blood suggests local production from the resected specimen, or at least from the area of resection. Cytokine production, especially of IL-6, was modified not only by the underlying disease itself, as higher levels were observed in Crohn's disease before colectomy, but also by the presence of perioperative septic complications.

Adult↗
PubMed1995

Pediatric liver transplantation for Langerhans' cell histiocytosis.

Langerhans' cell histiocytosis (LCH) represents 15% to 20% of sclerosing cholangitis (SC) in children. In LCH-associated SC, a very poor response to chemotherapy has been reported, and spontaneous prognosis is very bad. Few cases of orthotopic liver transplantation (OLT) for LCH have been reported and little is known about the risk of recurrence and the effect of immunosuppression after OLT. Since 1986, five children (mean age +/- SD, 12.6 +/- 3.6 years) underwent OLT for SC complicating LCH. All patients presented with growth retardation, and severe liver disease including repeated episodes of variceal bleeding (n = 5), liver insufficiency (n = 4), jaundice (n = 5), and ascitis (n = 4). Four patients presented with previous abdominal surgery (mesocaval shunt in two and explorative laparotomy in two). OLT was performed using a whole (n = 2) or a reduced liver graft (n = 3). Pathological examination of the recipient liver showed biliary cirrhosis in all cases. Three patients are alive and well 9 to 88 months after OLT. None presented with recurrence of LCH or SC within the liver graft or in other organs. General condition (including growth and puberty) improved dramatically in the three surviving patients. Absence of recurrence after up to 7 years of follow-up after liver transplantation in our patients, as well as in all other reported cases, is encouraging and shows that OLT may be indicated in end-stage liver disease complicating LCH. Furthermore, cyclosporine may be beneficial for preventing recurrence of LCH, in which autoimmunologic mechanisms have been advocated.

Adolescent↗
PubMed1994

[Surgery of cancers of the colon and rectum].

Whatever the technique used for colorectal resection, the carcinologic principles of resection of colorectal cancer must include removal of the cancer with an adequate margin by performing a wide excision of the tumor-bearing area and associated lymphatics. Recent advances in colorectal cancer management concern principally rectal cancer, with new diagnostic tools (i.e. endorectal ultrasound, MRI, CT-scanner), and new surgical procedures (ioff coloanal anastomosis, stapled anastomosis, and local excision) which allow, in most of the cases, a sphincter-saving resection to be performed. Indication of laparoscopic surgery in colorectal cancer remains to be determined. Prognosis of colorectal cancer has not improved for recent years and the 5 year survival rate remains close to 50% after surgical excision. However, recently, adjuvant chemo-and radio-therapy have permitted a significant reduction of local recurrences and an improvement of the overall survival.

Colonic Neoplasms↗
PubMed1994

Budd-Chiari syndrome with extensive portal thrombosis: treatment with Senning's procedure.

A patient with Budd-Chiari syndrome and associated extensive portal thrombosis, precluding any kind of portosystemic shunt, was treated with Senning's procedure. This technique, which includes dorsocranial hepatic resection and direct hepatoatrial anastomosis under total vascular exclusion of the liver, resulted in prompt recovery from acute hepatic failure and esophageal bleeding. Peroperatively, the hemodynamic status was secured with a venous cavo-caval bypass. This observation suggests that Senning's procedure is strongly indicated in the case of Budd-Chiari syndrome with extensive portal thrombosis.

Adult↗
PubMed1994

[Appendiceal localization of bilharziasis: value of extemporaneous histological examination].

The association of appendicitis with schistosomiasis in the appendix is extremely rare in France. We report herein a new case in which the diagnosis was made, in the presence of pseudo-tumoral appendicitis, by frozen section biopsies. The patient presented with a typical acute appendicitis, without urinary symptoms, and with granulocytosis (14000 white cells/mm3, without eosinophilia). At laparotomy, the appendix was voluminous, with necrotic abscess, and lymph node masses were noted on the greater omentum. Frozen section biopsies of an omental tumor showed schistosoma eggs, without malignant cells. Appendicectomy and partial omentectomy were performed. Postoperative course was uneventful. Pathologic examination of the resected specimen showed schistosoma eggs in all layers of the appendix, and in the omentum. Final diagnosis was established by positive serology and by findings Schistosoma haematobium eggs in the urine. The patient was treated postoperatively by praziquantel. In conclusion, in case of acute appendicitis, with pseudotumorous appendix and lymph node masses, even with poor epidemiological findings on the clinical history, frozen section biopsies can sometimes establish the diagnosis of schistosomiasis with appendicitis, and avoid unjustified bowel resection.

Adult↗
PubMed1994

Portosystemic shunt in Budd-Chiari syndrome: long-term survival and factors affecting shunt patency in 25 patients in Western countries.

BACKGROUND: In Budd-Chiari syndrome (BCS) treated by portosystemic shunt, postoperative shunt thrombosis is associated with high morbidity and mortality rates. The aim of this study was to determine factors associated with shunt thrombosis. METHODS: From 1985 to 1991, 25 patients underwent portosystemic shunt for BCS. According to the patency of the shunt during the postoperative period and follow-up, patients were divided into two groups including 17 patients with patent shunt and 8 (32%) with shunt thrombosis. RESULTS: In patients with patent shunt, actuarial survival rate at 5 years was 87% versus 38% in patients with shunt thrombosis (p < 0.05). Duration of symptoms before operation was higher in patients with shunt thrombosis than in patients with patent shunt (315 +/- 483 vs 109 +/- 168 days, p < 0.05). In patients with patent shunt, extensive fibrosis or cirrhosis was observed in 3 of 17 (18%) versus in 5 of 8 (63%) of patients with shunt thrombosis (p < 0.05). Shunt thrombosis was observed in 3 of 3 patients (100%) with the combination of myeloproliferative disorder, duration of symptoms more than 100 days, and cirrhosis versus 0 of 6 (0%) patients without this combination (p < 0.05). CONCLUSIONS: In acute form of BCS (with short history of the disease and absence of extensive fibrosis or cirrhosis), early portal decompression is mandatory, with low risk of shunt thrombosis and good long-term results. In chronic form of BCS, the risk of shunt thrombosis is high and long-term results are bad; in these patients, orthotopic liver transplantation must be considered.

Actuarial Analysis↗
PubMed1994

[Total duodenal diversion in reoperations for gastroesophageal reflux. Indications and results in 29 patients].

From January 1980 to December 1991, among 75 patients operated on for failed antireflux procedures, 29 (39%) underwent total duodenal diversion and are the basis of this report. Ten (34%) patients underwent several procedures for reflux disease before admission. Symptoms were observed during the first postoperative year in 80% of the patients. Total duodenal diversion was performed because of: oesophageal stricture (n = 11), hiatal hernia recurrence with impossibility to perform a new antireflux procedure (n = 9), columnar lined oesophagus (n = 6), alkaline reflux (n = 2), and oesophageal motricity disorder (n = 1). At follow-up (mean 32 months), 24 patients (83%) were a symptomatic or had only moderate symptoms.

Adult↗
PubMed1993

Regression of established macroscopic liver metastases after in situ transduction of a suicide gene.

The herpes simplex virus type 1 thymidine kinase (HSV1-TK) converts nontoxic nucleoside analogs such as ganciclovir into phosphorylated compounds that act as chain terminators and specifically kill dividing cells. This property could be exploited for the treatment of tumors that are made up of rapidly dividing cells invading a nonproliferating tissue. For this purpose, specific expression of the suicide gene into dividing tumor cells can be further targeted by using retroviral-mediated gene transfer. We investigated whether the direct intratumoral transduction of a suicide gene might induce the elimination of malignant solid tumors. Rats with established macroscopic liver metastases were given an intratumoral injection of packaging cells producing either HSV1-TK- or lacZ-expressing recombinant retroviral particles. All rats were next treated with ganciclovir. A dramatic regression of the tumor volume was observed in the HSV1-TK-treated animals. The residual tumors were mostly made up of a massive fibrotic reaction, with the mean cancer cell mass being reduced approximately 60-fold compared to controls. In some animals, the residual tumors were devoid of cancer cells. This treatment efficacy appears in part due to a "bystander effect" in which phosphorylated ganciclovir could be transferred from cell to cell and to an active local immune reaction evidenced by massive infiltration of the tumors by macrophages and both CD4+ and CD8+ lymphocytes. This efficient therapeutic approach might be an ultimate treatment for disseminated liver metastases in humans and could also be applied to treatment of a large variety of solid tumors.

Animals↗