[Recurrent pancreatic metastases from a hypernephroma].
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Aged↗
Biomedical subjects
B Sastre
Publications and source records attributed to B Sastre.
Distal pancreatic atrophy and diabetes associated with an intrapancreatic hydatid cyst.
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Aged↗
Pharmacokinetics and tissue penetration of single-dose cefotetan used for antimicrobial prophylaxis in patients undergoing colorectal surgery.
The pharmacokinetics and tissue penetration of cefotetan were studied after a single injection of 2 g given intravenously for antimicrobial prophylaxis to 16 consecutive patients undergoing colorectal surgery. Concentrations in tissue greater than or equal to the MIC for 90% of the main pathogens tested were considered adequate. The elimination half-life at beta phase was 4.6 +/- 1.4 h, the total body clearance was 0.75 +/- 0.19 ml/kg/min, and the volume of distribution was 260 +/- 71 ml/kg. At the time of incision (33 +/- 16 min after the injection), cefotetan concentrations were 14.2 +/- 7 micrograms/g in abdominal-wall fat, 16.4 +/- 1 micrograms/g in epiploic fat, and 163 +/- 62 mg/liter in serum. At the time of surgical anastomosis (151 +/- 54 min), cefotetan concentrations were 33.3 +/- 6 micrograms/g in the colonic wall and 73 +/- 34 mg/liter in serum. Upon closure of the abdomen (216 +/- 76 min), cefotetan concentrations were 6.3 +/- 3 micrograms/g in abdominal-wall fat, 6.1 +/- 4 micrograms/g in epiploic fat, and 64 +/- 38 mg/liter in serum. Cefotetan tissue penetration was 10% into abdominal and epiploic fat and 46% into the colonic wall. Levels in tissue were compared with the MIC for 90% of the most frequently encountered pathogenic germs (Staphylococcus aureus, Bacteroides fragilis, and Escherichia coli). Adequate concentrations in tissue were obtained up to anastomosis but not upon closure. The authors therefore recommend the injection of an additional dose of 1 g before closure in order to ensure optimal efficacy throughout the surgical procedure.
Cefotetan↗
Transhiatal bilateral splanchnicotomy for pain control in pancreatic cancer: basic anatomy, surgical technique, and immediate results in fifty-one cases.
The greater splanchnic nerves are largely responsible for innervation of the supramesenteric viscera; their section is known to be efficient to relieve pancreatic pain. Transhiatal splanchnicotomy (THS) is easily performed through a midline laparotomy. The nerve trunks are readily identified in the submediastinal space, far from the pancreatic cancer motivating splanchnicotomy, and can be sectioned safely and completely. After carrying out an anatomic study to determine the level of origin and mode of constitution of the greater splanchnic nerve trunk and its relations to the posterior and lower mediastinum, 51 patients underwent THS for intractable pain caused by unresectable pancreatic adenocarcinoma. THS alone was performed in 22 cases. THS was performed in association with biliary tract diversion or gastroenteroanastomosis in the other cases. All tumors were considered unresectable during surgery, and no patient was operated on with the sole purpose of performing THS. Two deaths (3.9%) were unrelated to THS. Specific morbidity was 6% (one pneumothorax, one chylothorax, and one splenic injury). Immediate postoperative functional results were good in 86.3% of patients treated by THS alone (group 1) and in 80.7% of patients treated by THS and bypass (group II). Functional results decreased to 72.7% in group I and 62.1% in group II, 3 months after surgery. In conclusion, THS appears to be an efficient technique for relief of pancreatic neoplastic pain and need not be combined or confused with medical percutaneous methods of neurolysis.
Aged↗
[Treatment of pseudocysts in acute pancreatitis. Retrospective study of 45 patients].
A total of 55 pancreatic pseudocysts in 45 patients with acute pancreatitis were managed between 1980 and 1990. Six patients were managed conservatively with resolution of pseudocysts in 5 patients. All pancreatic pseudocysts that disappeared were smaller than 35 mm. CT or ultrasound-guided aspiration were performed in 26 patients with a morbidity rate of 5%. Nine among 21 patients (42%) who were initially treated by percutaneous puncture were definitively cured: all pseudocysts were smaller than 55 mm. Nine patients were managed by long-term percutaneous drainage: 3 minor complications occurred and in 7 patients, no other treatment was necessary even for large pseudocysts. Endoscopic cystoenterostomy was performed in 12 patients. Only 15 pseudocysts (27%) bulged into the digestive wall, mainly of the stomach. Three complications (following 2 cystogastrostomies) occurred and one patient died after endoscopic cystogastrostomy. In 7 patients (58%), no other treatment was necessary even for large pancreatic pseudocysts. Surgery was required in 13 patients but only 4 patients underwent surgery as primary treatment. One major complication occurred and one patient died. Percutaneous drainage and endoscopic cystoenterostomy when technically feasible, are effective treatments of pancreatic pseudocysts complicating acute pancreatitis.
Acute Disease↗
Pharmacokinetics and tissue penetration of a single 1,000-milligram, intravenous dose of metronidazole for antibiotic prophylaxis of colorectal surgery.
The levels of metronidazole in serum and tissue penetration of metronidazole were studied after prophylactic administration in 11 patients undergoing elective colorectal surgery. A single dose of 1,000 mg given intravenously was administered before surgery. Adequate drug levels in serum (greater than or equal to MIC for 90% of strains tested [MIC90] for Bacteroides fragilis) were found in all patients throughout the procedure. Mean peak (15-min) and last-determined (24-h) metronidazole levels in serum were 28.8 +/- 8 and 4.2 +/- 1.7 mg/liter, respectively. The beta-phase elimination half-life was 9.5 +/- 2.3 h, and the clearance and apparent volume of distribution were 57 +/- 13 ml/min and 0.7 +/- 0.1 liter/kg, respectively. In the colonic wall at surgical anastomosis, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 91% of patients. In the abdominal wall fat and epiploic fat, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 40 to 60% of patients at surgical incision and closure. No anaerobic infection occurred during the study.
Aged↗
[Pharmacokinetics and tissue penetration of single-dose netilmicin used for antibiotic prophylaxis during colo-rectal surgery].
Pharmacokinetics and tissue penetration of netilmicin were studied after the use of a single dose (6 mg/kg) given for antibioprophylaxis in colo-rectal surgery. Thirteen patients, scheduled for elective surgery, were given 6 mg/kg IV netilmicin over 30 min, together with 1000 mg IV ornidazole. Netilmicin peak serum concentration (10 min after end of infusion) was 24.4 +/- 3.4 mg/l and trough level (24 h) was 0.9 +/- 0.5 mg/l. Plasma elimination half-life was 409 +/- 70 min, le volume apparent volume of distribution was 38 +/- 101 and total body clearance was 0.07 +/- 0.02 ml/min. Adequate netilmicin levels (5 greater than or equal to CMI 90 of involved pathogens Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus) were obtained in 100 per cent of patients in abdominal wall and epiploid fat, at time of opening, and in colonic wall at time of anastomosis. Adequate levels were obtained at time of closure in abdominal wall and epiploid fat in 92 to 100 per cent of patients. In situation of allergy to beta-lactam antibiotics, the use of netilmicin in combination with ornidazole may be recommended.
Aged↗
[Cancer of the rectum in elderly patients over the age of seventy-five years. Results of the surgical treatment].
The authors reviewed 122 rectal cancers observed over a period of 14 years in patients over the age of 75 years. Sixty-eight patients underwent extensive rectal resection, 17 were treated by local excision, and 28 only underwent a colostomy. Eight patients were excluded for surgery. The analysis of all of these groups showed that perioperative mortality was greater for large resections than for local resections, but with a lower recurrence rate and a higher survival at 3 years. Survival at 5 years after large resections was very close to the natural life expectancy for people of the same age. Moreover, survival was the quality of more comfortable than after local excision, and operative mortality was generally due to organ failure rather than to age itself. Radical surgery does not have to be systematically refused for very old patients, but he discussed in terms of the patients general status.
Actuarial Analysis↗
[Diagnosis and treatment of hydatid cyst of the liver].
Hydatid cyst of the liver is not uncommon in France. Its various symptoms often include pain, but chance discovery is not exceptional. The diagnosis is helped by two paraclinical examinations, ultrasonography and computerized tomography, which have become indispensable as they provide invaluable information on the precise location and anatomical rapports of the cyst and on possible complications. Laboratory tests are useful for the diagnosis and post-operative follow-up of these cysts. For the time being at least, treatment is purely surgical. Percutaneous needle aspiration and drainage have not yet proved to be totally innocuous, and medicinal treatments seem to be helpful only in cases with intraperitoneal rupture. The choice of the operative technique--essentially a more or less complete cystectomy--has an impact on surgical results: the operative mortality is usually low (2 to 5 p. 100), but the morbidity, mainly due to biliary tract complications of the cysts, remains as high as 30 p. 100.
Echinococcosis, Hepatic↗
pH regulation in human gallbladder bile: study in patients with and without gallstones.
Samples of gallbladder bile obtained from 25 controls and 34 patients with pigment (28 cases) or cholesterol (6 cases) gallstones were studied to establish whether disturbances in regulation of the biliary pH are likely to play a role in the pathogenesis of gallstones. Samples were assayed for pH, PCO2 and concentrations of sodium, bicarbonate and calcium (total and ionized). Saturation of bile in calcium carbonate was calculated. The main results of the study were as follows: (a) mean (+/- S.D.) PCO2 was significantly higher in gallbladder bile (6.72 +/- 0.36 kPa (in controls) and 7.63 +/- 0.29 kPa in patients) than in blood. This is consonant with previous results in animal species; it suggests that also in man a mucosal Na+ H+ antiport acidifies the gallbladder bile generating CO2 from biliary bicarbonate. (b) Biliary pH decreased when sodium concentration increased over a range of 140 to 280 mM. The pH decreased slightly when sodium increased from 140 to 200 mM and rapidly beyond this value; the rapid pH decrease in concentrated bile was associated with bicarbonate concentrations lower than 1 to 2 mM. The results showed that bicarbonate is the main buffer of gallbladder bile. (c) The pH decrease during bile concentration was similar in patients and controls. In both groups, fully concentrated bile was unsaturated in calcium carbonate. The results suggest that gallstone formation is not due to disturbances of biliary pH regulation. However, the normal concentration process that increases Ca++ concentration up to 4 mM and lowers pH values is likely to favor, in fully concentrated biles, the precipitation of calcium salts such as calcium bilirubinate.
Bicarbonates↗
Pharmacokinetics and tissue penetration of a single dose of ornidazole (1,000 milligrams intravenously) for antibiotic prophylaxis in colorectal surgery.
Levels in serum and tissue penetration of ornidazole were studied after a single intravenous injection of 1,000 mg given to 14 patients for prophylaxis of surgical infection. They were scheduled for elective colorectal surgery. Adequate levels in blood (greater than or equal to MIC for 90% of Bacteroides fragilis strains tested) were found in all patients throughout the procedure and up to hour 24. Mean-maximal (15 min) and last-determined (24 h) ornidazole levels in serum were 24 +/- 5.2 and 6.3 +/- 1.4 mg/liter, respectively. beta-Phase elimination half-life was 14.1 +/- 2.7 h, and clearance and apparent volume of distribution were 47 +/- 12 ml/min and 0.9 +/- 0.13 liters/kg, respectively. In all patient, adequate levels in tissue were found in the abdominal wall and the epiploic fat at time of incision and in the colonic wall at time of anastomosis. At time of closure, all but one patient had adequate levels in tissue in the abdominal wall and the epiploic fat. No anaerobic nor aerobic infection occurred in the study patients.
Aged↗
Image analysis for histochemical study of glucose-6-phosphatase inactivation by diethyl pyrocarbonate in normal human liver.
Glucose-6-phosphatase (G6Pase) is a multicomponent system that catalyzes G6P hydrolysis. To determine the specificity of the histochemical reaction of G6Pase, we investigated the inhibitory effect of diethyl pyrocarbonate (DEPC), a specific and very effective inhibitor of the phosphohydrolase component of the G6Pase system, in normal human liver. The inactivation of the histochemical enzymatic activity by DEPC was monitored by determining the mean brightness of the microscopic image and the histogram of light intensity distributions. The results obtained indicate that the histogram is more sensitive than the mean brightness to variations of enzymatic activities, and that the percent of pixels brighter than a convenient level is directly proportional to DEPC concentration. This study indicates that DEPC can be used as an efficient inhibitor of the histochemical reaction of G6Pase.
Diethyl Pyrocarbonate↗
[Tissue penetration of single-dose cefotetan used for antibiotic prophylaxis in colorectal surgery].
Pharmacokinetics and tissue penetration of cefotetan were studied after a single injection of 2 g for antibiotic prophylaxis in colo-rectal surgery. Beta half-life was 4.3 +/- 1 h, total body clearance was 0.74 +/- 0.2 ml/kg/min and volume of distribution was 270 +/- 76 ml/kg. At time of laparotomy, cefotetan concentration was 14.2 +/- 7 micrograms/g in abdominal wall fat and 16.4 +/- 1 micrograms/g in epiploic fat. In the colonic wall, cefotetan concentration was 33.3 +/- 16 micrograms/g. At time of abdominal closure, cefotetan concentrations were 6.3 +/- 3 micrograms/g in the abdominal wall fat and 6.1 +/- 4 micrograms/g in the epiploic fat.
Abdominal Muscles↗
Villous adenoma of the main pancreatic duct: a potentially malignant tumor?
This report deals with two cases of villous adenoma of the Wirsung duct. The two patients presented with upper abdominal pain, diarrhea, and weight loss. Duodenal intubation showed a complete failure of exocrine pancreatic function. Ultrasound scan, computed tomography, and endoscopic retrograde cholangiopancreatography disclosed marked dilatation of the head portion of the main pancreatic duct. A proximal duodenopancreatectomy was performed. Pathological examination revealed a papillary polyp expanding the pancreatic head and filling the main duct lumen. Histological pattern consisted of a villous adenoma without any feature of malignant change. Previously reported cases exhibit many similarities to our two cases. The putative likelihood of malignant change and the relationship between villous tumors of the Wirsung duct and of other origin remain unclear.
Adenoma↗
Activity measurements in human tissues of the methotrexate molecular target: a novel fluorometric assay.
As DHFR is the main molecular target of MTX, a widely used anticancer drug, its level in human tissues is likely to be one of the factors determining tissue sensitivity towards this drug. Forty-one biopsies were analyzed for their DHFR activity by a convenient spectrofluorometric assay developed in our laboratory; this sensitive method proved to be suitable for measurements in very small human samples. Statistical analysis of the results showed that (i) DHFR activity is not an index of tumorogenicity, at least in the cases studied, (ii) tumorous extracts contain modulators of DHFR activity.
Biopsy↗
[Carcinoma in situ in localized Caroli's disease].
A new case of Caroli's disease associated with cholangiocarcinoma is reported. It is the first in situ carcinoma description. Intrahepatic biliary cysts are a predisposing condition, even if mechanism remains hypothetical.
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[Immediate and late results of surgical treatment for chronic pancreatitis. Apropos of 127 operated cases].
From 1960 to 1987, 127 patients (105 males and 22 females, mean age: 45.9 years) underwent surgical treatment for CP. The aim of this study was to assess the results of surgical treatment intentionally oriented towards conservative surgical procedures (CPS). Ninety-one patients benefited from either pancreato-intestinal bypasses (84 cases) sometimes associated with other intestinal bypasses and/or transhiatal splanchnicotomy (THS) or isolated biliary (5 cases) or gastric (2 cases) bypasses. Thirty-one resections were carried out: 26 pancreatoduodenal resections (PDR) associated 3 times with TSH and 5 distal pancreatectomies. Other types of conservative treatment were performed in 5 cases. There were 5 post-operative deaths (3.9%): 1 after resection (6.6%) and 4 after CSP (p greater than 0.7). Postoperative complications occurred twice after resections (6.6%) and in 13 cases (16.2%) after CSP (p greater than 0.3). A further surgical procedure was required in 3 cases after pancreatic resection (3/25.12%) and in 14 cases after CSP (14/71, 19.7%) (p greater than 0.5). In the late postoperative course 15 deaths occurred but only 6 of them were directly related to the course of the pancreatitis. Five and 10 year overall survival probability after surgical treatment was respectively 81.5% and 64.7%. This probability was 70.4 and 60.4% after resections and 87.1% and 68.8% after CSP (p = 0.29). After CSP 75% of good functional results were observed between 1 and 4 years and 60% afterwards. Although non statistically significant these results suggest that: CSP and resections have the same operative risk, late reoperations are more frequent after CSP, the chance of late survival rate is better after CSP than after resection.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Antibiotic prophylaxis with a single dose of 1000 mg metronidazole or ornidazole in colorectal surgery].
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