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B Sastre

Publications and source records attributed to B Sastre.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Inhibition of peritoneal bacterial adhesion using oligosaccharides. An experimental model of peritonitis in rats].

BACKGROUND: Peritoneal colonization is a crucial event in the pathogenesis of peritonitis and its local complications. Adherence to the serosal mesothelium is mediated in a number of microorganisms derived from the digestive tract (especially E. coli) by type-1 fimbriae which have an oligosaccharide specificity. PURPOSE: To evaluate the effect of repeated peritoneal washes with saline solution and oligosaccharides on E. coli peritoneal adherence in a rat peritonitis model. METHODS: Sixty rats were randomized in 3 groups of 20. E. coli was inoculated at a constant concentration of 10(8)/mL per 100 g of weight. Then, peritoneal washes were achieved daily during three consecutive days (D1, D2, D3), with saline solution in Group I (control group), Methyl alpha-D-Mannoside (MADM) in Group II, and p-Nitro-phenyl alpha-D-Mannoside (pNADM) in Group III. Peritoneal samples were obtained before and after lavage at D1, D2, and D3. Microbial recovery was expressed as cfu/mg of tissue, and converted into a percentage of the initial value. A 10% threshold defined efficiency of the wash (inhibition of adherence for 90% of bacteries). RESULTS: Compared with data from Group I, E. coli peritoneal adherence was significantly lower after washes in Group III (D1: p = 0.03; D2: p = 0.009; D3: p = 0.003). Repeated washes were more efficient in Group III than in Group II (D1: p = 0.1; D2: p = 0.5; D3: p = 0.001). CONCLUSION: These results suggest that the addition of oligosaccharides, especially of pNADM, reduces the peritoneal adherence of E. coli when a peritoneal wash is performed for peritonitis.

Animals↗
PubMed1999

Omentoplasty in the prevention of deep abdominal complications after surgery for hydatid disease of the liver: a multicenter, prospective, randomized trial. French Associations for Surgical Research.

BACKGROUND: Omentoplasty (OP) is thought to fill residual cavity, to assist healing of raw surfaces, and to promote resorption of serosal fluid and macrophagic migration in septic foci. Results published to date, whether retrospective or prospective, are not controlled and are discordant. STUDY DESIGN: The authors investigated whether OP, either filling the residual cavity after unroofing, or covering the hepatic raw surface after pericystectomy, could reduce the rate or severity of deep abdominal complications (DAC) after surgical treatment of hydatid disease of the liver. Between January 1993 and December 1996, 115 consecutive patients (51 males and 64 females, mean age 42+/-16 years [range 10 to 80 years]) with previously unoperated uni- or multilocular hydatid disease of the liver, complicated or not, without other abdominal hydatid disease, were randomly allotted to OP (n = 58) or not (NO) (n = 57) after unroofing, total, or partial pericystectomy. Patients were divided into 2 strata according to the site of the cyst with respect to the diaphragm: a) posterosuperior segments II, VII, and VIII or b) anterior segments III, IV, V, and VI. Main outcomes measures included deep bleeding, hematoma, infection, or bile leakage. Subsidiary measures included wound complications, extraabdominal complications, duration of operation, and length of hospital stay. RESULTS: Both groups were comparable regarding patient demographics, cyst characteristics, intraoperative procedures, search for bile leaks, and intraoperative transfusion requirements. On the other hand, more patients (86%) in NO had associated drainage of the abdominal cavity than in OP (64%) and the duration of operation was 9 minutes longer in OP, but neither of these differences was statistically significant. Less DAC occurred in OP (10%) than in NO (23%) (a posteriori gamma risk < 0.05) and fewer deep abdominal abscesses (0 versus 11%) (p < 0.03). Median duration of hospital stay, however, was similar. CONCLUSIONS: OP decreases the rate of DAC and especially deep abdominal abscess after surgical treatment (unroofing or pericystectomy) for hydatid disease of the liver and should be recommended in this setting.

Adolescent↗
PubMed1998

Insulin-like growth factor (IGF)-binding protein-3 (IGFBP-3) proteolysis in patients with colorectal cancer: possible association with the metastatic potential of the tumor.

The limited proteolysis of insulin-like growth factor (IGF)-binding protein (IGFBP)-3 is a key event in the regulation of endocrine bioavailability of IGFs. Here, we investigated IGFBP-3 and IGFBP-3 proteolysis in serum from patients with colorectal cancer both before and at different times following surgery. In vivo IGFBP-3 proteolysis, estimated by immunoblot analysis of IGFBP-3 fragments in serum, and in vitro IGFBP-3 protease activity of serum, estimated by a 125I-IGFBP-3 degradation assay, allowed us to identify 2 groups of patients (IGF-M vs. IGF-NM) with respect to their status for mobilizing the IGF system. In IGF-M patients, in vivo and in vitro IGFBP-3 proteolysis were significantly elevated (156% and 181% of the age-matched control pool, respectively) and accompanied by a decrease in intact IGFBP-3 (38% of the control pool). The IGFBP-3 proteolytic processing was further increased in response to surgical ablation of the tumor (mean increase 45-55%), then gradually returned to levels comparable with controls. In contrast, IGF-NM patients exhibited a minimal alteration of in vitro IGFBP-3 protease activity and even an inhibition of in vivo IGFBP-3 proteolysis, whereas intact IGFBP-3 was unaltered when compared with controls. Moreover, this pattern was not further significantly altered in response to the surgical stress. None (0/6) of the IGF-M patients vs. 70% (5/7) of the IGF-NM patients developed a metastatic disease (median duration of follow-up 26 months). Neither elevated amounts of pro-IGF-II nor presence of detectable IGFBP-3 protease inhibitors in the circulation could explain the observed suppression of IGFBP-3 proteolytic processing in IGF-NM patients. These results indicate that inhibition of IGFBP-3 proteolysis and invasive properties of cancer cells are related in colorectal cancer patients.

Adenocarcinoma↗
PubMed1998

[Is there a correlation between dietary habits and hemorrhoidal disease?].

OBJECTIVES: It is empirically accepted that certain foods play a role in the pathogenesis of hemorrhoids or their acute exacerbation. The aim of this work was to determine whether there is a relationship between hemorrhoids and certain food-related or common toxin-related factors. PATIENTS AND METHODS: Two groups of 50 subjects were compared. Group I was composed of 50 patients with hemorrhoid symptoms. Fifty volunteers with no proctologic abnormality were included in group II. We used a diet survey to compare total calorie, protein, carbohydrate, fat, food fiber, water, alcohol, salt, pepper, pimento, tea, and coffee intake was well as smoking habits. Episodes of constipation were also noted. RESULTS: Overall calorie intake, as well as protein, carbohydrate and fiber intake were similar in the two groups as were use of salt, coffee and tea. Dietary intake in group I was higher for fat (p = 0.02), alcohol (p = 0.01), pepper (p = 0.04, and pimento (p = 0.001). Subjects in group I drank less water (p = 0.008), smoked more (p = 0.01) and were more often constipated (p < 0.001) than those in group II. CONCLUSION: Our findings provide further arguments suggesting that dietary imbalance or smoking could be involved in the development of hemorrhoids. These factors should be evaluated in appropriate dietary inquiries. Epidemiological surveys would be required to confirm their possible causal effect.

Alcohol Drinking↗
PubMed1998

[Malignant tumors of the ampulla of Vater. Results of radical excision. A study of 39 cases].

STUDY AIM: From 1971 to 1995, 39 patients underwent curative resection of a malignant tumor of the ampulla of Vater. The aim of this retrospective study was to report long-term results and to determine factors influencing survival in these patients. PATIENTS AND METHODS: Data was collected from patient record analysis, correspondence with patients, their family or general physician. Kaplan-Meier method was used to compare survival data by the log-rank test. Multivariate analysis evaluated the impact of each variable on survival. Values with a P value of 0.05 or less were considered statistically significant. RESULTS: Resection consisted of pylorus preserving pancreaticoduodenectomy (n = 21) or pancreatico-duodenectomy associated with an antrectomy (n = 18). Overall mortality rate after resection was 10% (n = 4). General and specific morbidity rates were 71% and 2.5%. During the course of the follow-up (completeness: 100%) mean survival was 80 months (median: 37 months, range: 6-227 months). Five-year survival rate was 35%. Factors favorably influencing long-term outcome were exposed protruding and well differentiated tumors (P = 0.03, P = 0.01, respectively) and negative lymph node status (P = 0.0001). Prognosis was poorer if tumor was extended into the pancreas (P = 0.04). Among proposed histoprognostic classifications (classifications of Martin, Talbot, Shiraï, Yamaguchi), an excellent correlation was obtained only with TNM classification (P = 0.0001). CONCLUSION: Results of the present study suggest that prolonged survival can be obtained following radical resection of a malignant tumor of the ampulla of Vater, especially for exposed protruding and well differentiated tumors, without extension into the pancreas or lymph node metastasis. TNM classification provides an excellent predictive value and should be used more systematically.

Adult↗
PubMed1998

Eosinophilic pancreatitis mimicking pancreatic neoplasia: EUS and ERCP findings--is nonsurgical diagnosis possible?

Eosinophilic pancreatitis is a rare disease with, to date, only 10 reported cases. We report two patients whose presentation was suggestive of a pancreatic tumor. An 18-year-old man presented with a short history of obstructive jaundice, epigastric pain, and weight loss. Endoscopic ultrasonography revealed a 12-mm round, hypoechoic lesion in the head of the pancreas, suggestive of a pancreatic endocrine tumor. A duo-denopancreatectomy was performed, and the patient made an uneventful recovery. A 64-year-old man was referred with weight loss and obstructive jaundice due to a stricture of the common bile duct. Retrograde pancreatography demonstrated a very narrow, regular main pancreatic duct and early parenchymography. Endoscopic retrograde cholangiopancreatography revealed a tight, regular stenosis of the intrahepatic portion of the common bile duct. A gastrojejunal anastomosis and biliary-digestive bypass were performed without postoperative complications. In both cases, the diagnosis of eosinophilic pancreatitis was revealed after surgical resection. The features of eosinophilic pancreatitis, including eosinophilic infiltration of the digestive wall, a history of atopy, and the radiological characteristics are described. If these are of sufficient discriminatory value, unnecessary surgery may be avoided.

Adolescent↗
PubMed1997

Simultaneous bilateral oophorectomy does not improve prognosis of postmenopausal women undergoing colorectal resection for cancer.

PURPOSE: Synchronous or metachronous ovarian metastases are common along the natural course of colorectal carcinoma. We attempted to prospectively assess the prognostic impact of simultaneous bilateral oophorectomy in postmenopausal women undergoing curative resection for colorectal cancer. METHODS: Between 1980 and 1990, simultaneous bilateral oophorectomy was proposed in each postmenopausal woman referred to our institution for treatment of colorectal cancer. A subset of 92 patients underwent a curative resection. Therefore, two groups were designed for comparison of the procedure. Group I included 41 patients who accepted surgical castration, and Group II consisted of the 51 remaining patients who refused. Prospective analysis of all patients was performed. Results were assessed with a follow-up of 60 months after surgery, with 97.9 percent completion. Local recurrence and liver metastases rates were compared by the chi-squared test. Survival in each group was calculated by the Kaplan-Meier method and compared by the log-rank test. RESULTS: One patient (1/41; 2.4 percent) had ovarian metastases detected on the operative specimen. Local recurrence or liver metastases rates were not affected by oophorectomy (P = 0.73; P = 0.25). Five-year actuarial survival rates were not significantly different whether patients had oophorectomy (81.6 percent) or not (87.9 percent; P = 0.62). CONCLUSIONS: Our results suggest that microscopic synchronous ovarian metastasis is rare at the time of curative resection of a colorectal carcinoma in postmenopausal women. Because simultaneous bilateral oophorectomy does not modify prognosis, this procedure seems to be unwarranted.

Adenocarcinoma↗
PubMed1997

Colonic perforation due to colonoscopy: a retrospective study of 48 cases.

BACKGROUND AND STUDY AIMS: The aim of this retrospective study was to analyze data on the treatment of 48 cases of colonic perforation, with a view to defining the criteria for choosing between medical and surgical treatment. PATIENTS AND METHODS: A questionnaire requesting information about complications of colonoscopy and their treatment was sent out to four hospital gastroenterological and surgical units. RESULTS: From January 1979 to December 1993, we reviewed the records of 48 cases of colonic perforation following colonoscopy (24 perforations occurred after diagnostic colonoscopy and 24 after therapeutic colonoscopy). Diagnosis of perforation was delayed in 42% of the patients, with a mean delay of two days (range 0.5-7 days). The treatment was surgical in 35 cases, including eight in which previous medical treatment had been unsuccessful. The perforation was in the sigmoid colon in 74% of the surgical population. Operations were carried out using two procedures, including colostomy, in the case of 20 patients (57%). Colostomy closure was performed in 12 patients (60%) with no mortalities. Surgical mortality occurred in five patients (14%), in four cases due to preexisting medical diseases. Medical treatment was attempted in 21 cases, and was successful in 13, mainly in cases in which perforation had occurred after therapeutic colonoscopy (12 patients). CONCLUSION: The choice of the right type of treatment for colonoscopic perforation seems to depend on the size of the lesion. Surgical treatment is appropriate when the perforation has occurred during diagnostic colonoscopy, since the lesion in this case is usually a large colonic laceration, whereas nonsurgical treatment seems to be justified after polypectomy, as long as there is rapid clinical improvement.

Adolescent↗
PubMed1997

Concentrations of prophylactic ceftriaxone in abdominal tissues during pancreatic surgery.

Ceftriaxone concentrations in abdominal tissues were evaluated after administration as antibiotic prophylaxis for pancreatic surgery. Ten patients were given ceftriaxone (1 g i.v.) 30 min before surgery. Ceftriaxone concentrations in fatty tissues ranged from 2.5 to 6.2 microg/g. Ceftriaxone concentrations were 6.0 +/- 8.6 microg/g in pancreatic tissues, 2.1 +/- 2.5 mg/L in pancreatic fluid, 1179 +/- 1271 mg/L in pancreatic bile, and 18 +/- 16 microg/g in the liver. In fatty tissues, 8-10 patients had tissue levels greater than the MIC90 for Staphylococcus aureus and Escherichia coli and the 10 patients had tissue levels greater than the MIC90 for Klebsiella pneumoniae and Proteus mirabilis. In other tissues, penetration was greater than the MIC90 for potential pathogens in 50-100% of the patients.

Abdominal Muscles↗
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↗
PubMed1997

Analysis by confocal laser scanning microscopy imaging of undilated bile canaliculi F-actin staining in the hepatocytes of human extrahepatic cholestatic liver.

Many studies have demonstrated the role of bile canalicular microfilaments in bile secretion and bile flow. It is now admitted that modification of bile canalicular network of microfilaments play a role in dysfunction of bile secretion observed in many cases of cholestasis. This work intends to study F-actin, a major component of microfilaments, in human hepatocytes in extrahepatic cholestasis. Normal and extrahepatic cholestatic liver were studied. F-actin was stained with fluorescent phallotoxin and quantified by using confocal laser scanning microscopy and an image analysis method. Mean specific fluorescence (MSF) of bile canaliculi was measured. Since dilated and bile plugged canaliculi were rarely observed in cholestatic liver sections, only undilated bile canaliculi were analysed. Bile canalicular MSF was significantly increased (p < 0.05) in cholestatic hepatocytes (1.3 to 1.7 fold higher than in controls). These data demonstrate a pericanalicular thickening of F-actin microfilaments in human extrahepatic cholestatis, similar to that described in literature in many cases of human intrahepatic and extrahepatic cholestasis cases as well as in experimentally induced cholestasis. However, further studies are needed to understand this increase in F-actin pericanalicular microfilaments in human extrahepatic cholestasis.

Actin Cytoskeleton↗
PubMed1997

[Early postoperative morbidity after hemorrhoidectomy using the Milligan-Morgan technic. A retrospective studies of 1,134 cases].

Milligan and Morgan's procedure is commonly used for the surgical management of haemorrhoids. The aim of our study was to evaluate short term postoperative morbidity. Between 1975 and 1990, 1,134 patients were operated on. Two patients died after operation. The most frequent complications were pain (71%) and urinary retention (16.4%). Hemorrhages (7.6%) resulting in a re-operation occurred in 1% of cases. Other complications were rare and always cured by a specific treatment (stenosis: 2.9%, anal fissure: 0.5%, abscess: 0.6%, fistula in ano: 1.2%). Two patients had anal incontinence partially improved by biofeedback. Hemorrhoidal was 2%. Short term postoperative morbidity is generally low after Milligan and Morgan hemorrhoidectomy, with careful supervision in a surgical department and repeated postoperative care.

Abscess↗
PubMed1996

[Laparoscopic cholecystectomy in a patient with Steinert disease].

Steinert's disease or myotonic myopathy is associated with chronic restrictive respiratory insufficiency. A case of a patient with Steinert's disease undergoing laparoscopic cholecystectomy, with a full recovery within three days is reported. It is concluded that laparoscopic surgery is a possible therapeutic tool in patients suffering from a myopathy.

Adult↗
PubMed1996

[Rectopexy to the left inguinal ligament. Technique and preliminary results].

We report the procedure and the results of a new surgical technique for adult rectal prolapse by left inguinal ligament rectopexy. Seven patients were operated on, and presented with total rectal prolapse (n = 6) or internal procidentia associated with a solitary rectal ulcer syndrome (n = 1). Mean follow-up was 64 months (56-78 months). One patient experienced a postoperative complication: a regressive temporary dysesthesia of the left lateral femoral cutaneous nerve. Three patients had mild postoperative constipation. There was no recurrence. Preliminary results show that it is a suitable procedure. It may be successfully applied to the treatment of rectal prolapse and internal procidentia complicated by a solitary rectal ulcer syndrome, particularly when the use of synthetic material is precluded after a rectal wound. Further studies are required to confirm these preliminary results.

Adult↗
PubMed1996

[Pancreatic and duodenal somatostatinoma. Two clinico-pathologic entities].

Somatostatinomas are endocrine tumors with predominant secretion of somatostatin. The majority occur in the pancreas and the duodenum. However, distinctive clinico-pathologic features are reported for both of them. The features of pancreatic somatostatinomas are a larger size, a more frequent clinical expression, a female predominance and a poorer prognosis. Duodenal somatostatinomas are characterized by psammoma bodies at histologic examination. We report here two cases of pancreatic and ampullary somatostatinomas, focusing on the main diagnostic problems and on the characteristics of each tumoral localization.

Aged↗