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C Bastid

Publications and source records attributed to C Bastid.

At least 19 recordsLinked to original sources
PubMed2004

Endoscopic augmentation of the lower esophageal sphincter for the treatment of gastroesophageal reflux disease: multicenter study of the Gatekeeper Reflux Repair System.

BACKGROUND AND STUDY AIMS: The safety and effectiveness of the Gatekeeper Reflux Repair System (Medtronic Europe, Tolochenaz, Switzerland) in the treatment of gastroesophageal reflux disease (GERD) was evaluated. This new, reversible treatment modality involves the endoscopic introduction of expandable polyacrylonitrile-based hydrogel prostheses into the esophageal submucosa to augment the lower esophageal sphincter (LES). PATIENTS AND METHODS: For this study, data from two prospective, nonrandomized European multicenter trials were pooled. Sixty-nine GERD patients with heartburn and regurgitation and abnormal esophageal acid exposure (24-h pH < 4.0 for > 4 % of the total time) who had responded to proton-pump inhibitor (PPI) therapy were recruited, and 68 were treated with up to six prostheses placed at the gastroesophageal junction. Patients underwent esophageal manometry, endoscopy, 24-h pH-metry, and symptom scoring at intake and 1, 3, and 6 months after the procedure. RESULTS: A total of 77 procedures were performed in 67 patients, and a total of 270 prostheses were placed (mean 4.3 per procedure). At 1 and 6 months, 80.4 % and 70.4 % of the prostheses were retained, respectively. At 6 months, 24-h pH-metry outcomes with pH < 4.0 for > 4.0 % of the time decreased from 9.1 % to 6.1 % (n = 45; P < 0.05). Median LES pressure increased significantly from 8.8 mmHg at baseline to 13.8 mmHg at 6 months (n = 42, P < 0.01). Median GERD heartburn-related quality-of-life scores improved significantly from 24.0 to 5.0 (n = 53, P < 0.01) in patients no longer receiving PPI therapy. Two serious adverse events (3.0 %) occurred. Both patients recovered uneventfully. Prostheses were endoscopically removed from one patient without any adverse events. CONCLUSIONS: The Gatekeeper Reflux Repair System is a safe endoscopic treatment modality that significantly improves GERD symptoms and has objective effects on acid reflux.

Adult↗
PubMed2001

Intraductal papillary or mucinous tumors (IPMT) of the pancreas: report of a case series and review of the literature.

OBJECTIVE: Despite a better understanding of these conditions, intraductal papillary or mucinous tumors (IPMT) of the pancreas still present difficulty relating to the predictive factors of malignancy and the risk of relapse after surgical resection. The aim of this study was to report on our experience and to compare it to previously published cases. METHODS: We studied retrospectively 26 patients (mean age 60.3 yr) presenting with IPMT. Of the 26 patients, 19 had surgical resection and seven did not. The main clinical feature was acute pancreatitis occurring in 38% of the patients. Segmental pancreatectomy was performed in all the cases. At pathological assessment of resection margins, tumor resection was considered as complete in 17 cases. Margins exhibited benign mucinous involvement, and resection was considered to be incomplete in one multifocal case and in one case with diffuse spread of the tumor. RESULTS: A total of 11 tumors were benign and five were malignant. Carcinomas were invasive in four cases (two invading the pancreatic parenchyma, one the duodenum, and one the peripancreatic nodes) and in situ in one case. Malignancy was not diagnosed preoperatively except when invasion was evident (duodenal spread). Although main pancreatic duct type and obstructive jaundice appeared as suggestive features for the risk of malignancy, no reliable preoperative predictive factors for malignancy could be identified as regarding to clinical parameters, biological examinations, carcinoembryonic antigen or CA19-9 levels in serum or in pure pancreatic juice, imaging, and cytological methods. Within 40.8 months mean follow-up after surgery (range 2-96 months), three patients (16%), two with malignant and one with benign tumor, had tumor relapse after respectively 7, 27, and 14 months. Margins were positive without malignant features in the two malignant cases and negative in the other case. Tumor relapse was malignant with diffuse spreading in the three cases, and the patients died within 34 months after surgical resection. CONCLUSIONS: Our series and the review of the literature indicate that preoperative indicators of malignancy in IPMT are still lacking. Concerning resection margins, complete tumor resection is usually possible by segmental pancreatectomy. Malignant relapses are not exceptional. Incomplete resection and diffuse or multifocal tumor represent poor prognostic factors. Total pancreatectomy should be considered in such cases.

Adenocarcinoma, Mucinous↗
PubMed1995

Ultrasound guided percutaneous ethanol treatment of hepatic neoplasms: a therapeutic alternative in the nineties.

This paper describes ultrasound guided percutaneous ethanol treatment of hepatocellular carcinoma (HCC), which was introduced in 1985 as an alternative to surgical resection. Previous studies have reported the applicability of this technique to tumors less than 50 mm in diameter. In our own work, we have successfully treated tumors as large as 70 mm in diameter with very large volumes of absolute ethanol.

Carcinoma, Hepatocellular↗
PubMed1994

Percutaneous treatment of hydatid cysts under sonographic guidance.

Nine patients (five males, four females) with 14 hydatid cysts were treated with albendazole and percutaneous drainage under sonographic guidance. All but two cysts were hepatic. The average cyst diameter was 81.5 mm (range: 42-180 mm). There were eight type 1 cysts, two type 2, three type 3, and a single type 4. Type 1 and 2 cysts were treated by needle aspiration, type 3 and 4 by needle decompression and catheter drainage. The residual cavity was irrigated with 30% hypertonic saline and injected with absolute alcohol. Biliary fistulization contraindicated alcohol use. All cysts were successfully treated. A single episode of reversible anaphylaxis was encountered. Serial sonographic examinations revealed residual cavities ranging from 10 to 35 mm in diameter. No new cysts were noted during an average follow-up of 9.6 months. The mean hospital stay was 48 hr. Percutaneous drainage of hydatid cysts is a relatively safe and cost-effective procedure.

Adult↗
PubMed1993

Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients.

One hundred and forty-three patients presenting with 170 cysts and pseudocysts complicating chronic pancreatitis were followed between 1980 and 1990. Thirteen patients were managed conservatively and pseudocysts spontaneously disappeared in 11 patients. Cysts were small (average 28 mm), often communicating with the ductal system without dilatation of the main pancreatic duct. Percutaneous puncture was performed in 47 patients with a low morbidity rate (5%) but a high rate of recurrence (57%). Thirteen of 39 patients (33%) who underwent percutaneous puncture as initial treatment did not require further therapy. Communication of pancreatic cysts with the ductal system was associated with poorer results after percutaneous puncture. Percutaneous drainage was performed in 9 patients with a low morbidity rate (12%). The mean duration of drainage was 10.4 days. Five patients were definitively cured. Seventy-eight endoscopic cystoenterostomies were performed in 71 patients. Complications occurred in 12 patients (15.3%) and one patient died (1.3%). Endoscopic cystoenterostomy was effective in 39 of 54 patients initially treated with this technique (72.2%). Sixty-three patients underwent surgical management, principally internal drainage (83%), with a morbidity rate of 13.2% and a mortality rate of 1.3%. Twenty-one of the 29 patients (72%) who underwent surgery as initial treatment did not require further therapy. Endoscopic cystoenterostomy is an efficient treatment of cysts and pseudocysts complicating CP when anatomical conditions are favorable. Percutaneous drainage also appears to be a satisfactory treatment modality. Surgery should be considered in cases of failure or technical impossibility of endoscopic or percutaneous approaches.

Chronic Disease↗
PubMed1992

[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↗
PubMed1991

[Percutaneous ethanol injection of malignant liver tumors under ultrasonographic guidance].

16 patients (14 males, 2 females, mean age: 59.2 years) underwent sonographic-guided ethanol injections as treatment for 23 hepatocellular carcinomas (HCC) complicating cirrhosis. All lesions were pathologically proven by sonographic-guided cytology. Tumor sizes ranged from 9 to 66 mm. Sterile 96% alcohol was injected with a 17.7 cm-long 22 gauge spinal needle at one week intervals. At each session, 8-50 ml was injected depending on the diameter of the tumor. We regarded as a "success" the negativation of the cytologies one, two and three months after the end of the treatment associated with normalization of alpha-fetoprotein levels and typical echographic and tomodensitometric changes. No serious complication was associated with the procedure. In the "Child A" group1, 6 of 7 tumors have been successfully treated, the largest measuring 66 mm. The seventh lesion is currently being treated. In the "Child B" group1 3 of 6 lesions have been successfully treated. No success has been obtained in the "Child C" group. Volumes of alcohol greater than previously reported may be useful for lesions larger than 40 mm. Percutaneous alcohol injections can be considered as an alternative to surgery even for lesions larger than 50 mm. Among 4 patients presenting with 11 liver metastases of colic and gastric adenocarcinoma and 1 patient with a small bowel carcinoid tumor, one remission with a follow-up of 5 months was observed.

Aged↗
PubMed1991

Carcinoembryonic antigen has a different molecular weight in normal colon and in cancer cells due to N-glycosylation differences.

Carcinoembryonic antigen, an apical membrane glycoprotein expressed in normal human colonic epithelial cells, colonic polyps, tumor, and tissue culture cell lines originating from colonic adenocarcinomas, is generally considered to have a molecular weight of 180,000. Using sodium dodecyl sulfate-polyacrylamide gel electrophoresis associated with immunoprecipitation or immunoblotting with both monoclonal (Mab 517 and Mab 601) and polyclonal antibodies, we observed that carcinoembryonic antigen was actually expressed as two discrete apparent molecular weight forms in normal tissues: a broad band averaging at Mr 200,000 and a sharp band at Mr 130,000. This constituted the phenotype of the normal colon. In cancer cells we detected a single band at Mr 170,000 or lower. This variation was mainly the consequence of a modification of the glycosylation pattern of the molecule since deglycosylation by N-glycanase or biosynthesis in the presence of tunicamycin always produced a single molecular weight form, whether or not the source of tissue was normal or cancerous. By close inspection of benign, moderately transformed, and carcinomatous human colonic polyps we noticed that this shift in the molecular weight of carcinoembryonic antigen preceded the detection of other cancer markers such as nonspecific cross-reacting antigen at Mr 95,000 or the histological modifications leading to malignant diagnosis. Carcinoembryonic antigen constitutes, therefore, an important model with which to study the modifications of the glycosylation pattern induced during cancer biogenesis.

Carcinoembryonic Antigen↗
PubMed1991

[Percutaneous echography-guided alcohol block of the celiac plexus as treatment of painful syndromes of the upper abdomen: study of 21 cases].

Celiac plexus block is usually performed under fluoroscopic or tomodensitometric guidance. We report on a new procedure using sonographic guidance. the patient lies in supine position. We use a real-time sonograph with a 3.5 MHz probe. On a transverse plane, the celiac axis is localized emerging from the aorta. Under local anesthesia, the tip of the spinal needle (177 mm, 22 g) is placed close to the aorta (about 5 mm) on both sides. 5 to 10 ml of 1% lidocaine, then 10 to 20 ml of absolute alcohol, are injected on each side. 21 patients (10 males, 11 females, mean age: 61.4) underwent the procedure. They presented with cancer of the pancreas in 14 cases, metastatic nodes from an extra-pancreatic tumor in 5 cases and chronic calcifying pancreatitis (CCP) in 2 cases. No pain relief was secured in 3 patients (14%). One of these presented with CCP, but endoscopic cystic diversion of a small cyst was successful in eradicating pain. Partial pain relief was secured in 5 cases (24%) and total pain relief in 13 cases (62%). No treatment-related complication was observed. We conclude that sonography is a simple and safe method of guidance in performing alcohol block of the celiac plexus. The anterior approach may prevent neurologic complications occurring with other methods of guidance using a posterior approach.

Abdominal Pain↗
PubMed1991

Mucinous ductal ectasia of the pancreas: a premalignant disease and a cause of obstructive pancreatitis.

Five cases of localized ectasiae of pancreatic ducts associated with epithelial mucinous metaplasia have been previously reported by Itai et al. (Radiology 1986; 161:697-700). During a 1-year period, we collected four new observations of patients presenting with recurrent attacks of pancreatic pain due to similar clusters of cystlike dilated ducts communicating with the main pancreatic duct and lined by a columnar epithelium interspersed with numerous goblet cells. Duct lumina were filled with mucous. Carcinoembryonic antigen levels were high in the pure pancreatic juice, but normal in the blood. Sonography and CT scan showed cystlike, intrapancreatic defects localized three times in the head of the pancreas and once in the body. Endoscopic retrograde cholangiopancreatography (ERCP) showed a huge dilation of some collateral ducts filled by radiolucent defects. The main pancreatic duct was dilated proximally to pathological ducts in three cases. Neither pancreatic stones nor exocrine insufficiency could be demonstrated 7 years after the clinical onset; one case presented with an in situ carcinoma. Since mucinous ductal ectasia is a precancerous state, surgery is mandatory. ERCP is probably the best method of diagnosis.

Adult↗
PubMed1991

Persistence of the X-ray-transparent matrix of vanishing pancreatic stones.

We present three observations of patients with chronic calcifying pancreatitis with multiple pancreatic calculi visible on X-ray films of the abdomen. These patients were studied with plain films and sonography. On X-ray films, visible calcifications disappeared. In contrast, sonography and computerized tomography showed that the X-ray-transparent material of stones persisted. It is known that these stones are composed of different insoluble residues of PSP-S2-5, the secretory calcium stabilizer of pancreatic juice. This shows that the spontaneous or drug-induced disappearance of pancreatic stones on radiologic films is not sufficient for healing chronic calcifying pancreatitis.

Adult↗