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C Cellier

Publications and source records attributed to C Cellier.

72 records · Page 4Linked to original sources

[False radiologic pneumoperitoneum. The value of emergency abdominal computed tomography].

We report 2 cases of false pneumoperitoneum. The diagnosis was suspected on an upright chest or abdominal plain films. The absence of clinical signs and symptoms of peritoneal irritation suggested a wrong radiological diagnosis. Emergency CT scan definitely eliminated a pneumoperitoneum and suggested the right diagnosis in both cases. This exam may play the decisive role in preventing needless emergency laparotomy.

Aged↗

Endosonographic features of pancreatic metastases.

BACKGROUND: Pancreatic metastasis is a rare event. Surgical resection can provide long-term survival in selected cases. The aim of this study was to describe the endosonographic features of pancreatic metastases. METHODS: Among the 7000 endoscopic ultrasound (EUS) examinations of the pancreas performed between 1989 and 1993, 7 were performed in patients with pancreatic metastases that were histologically confirmed (6 by surgery, 1 by CT biopsy). Videotapes of the EUS procedures were re-examined. Metastases were from four renal cell carcinomas, one ovary carcinoma, one chondrosarcoma, and one neuroendocrine carcinoma of the gallbladder. RESULTS: A solitary lesion was imaged by EUS in six cases and 10 lesions were seen in one case. Fifteen of 16 lesions were slightly hypoechoic or isoechoic in comparison with the adjacent pancreas. They were homogeneous, round, well circumscribed and were associated with an enhancement of the ultrasonic beam. The association of these ultrasonographic patterns was different from that usually observed in cases of primary pancreatic carcinoma. In one case (ovary carcinoma), the lesion was hypoechoic, with heterogeneous infiltration and indistinct margins and with the marked attenuation of the ultrasonic beam that is commonly noticed in primary pancreatic carcinoma or in focal chronic pancreatitis. CONCLUSION: Endosonographic features of pancreatic metastasis are usually different from those observed in cases of pancreatic carcinoma.

Adult↗

Correlations between clinical activity, endoscopic severity, and biological parameters in colonic or ileocolonic Crohn's disease. A prospective multicentre study of 121 cases. The Groupe d'Etudes Thérapeutiques des Affections Inflammatoires Digestives.

The relationships between clinical activity, endoscopic severity, and biological parameters in Crohn's disease have not been thoroughly investigated and a link was therefore sought between these three elements. The following parameters were determined simultaneously in 121 consecutive patients with colonic or ileocolonic Crohn's disease: Crohn's disease activity index, Crohn's disease endoscopic index of severity, and serum albumin, alpha 2-globulin, alpha 1-antitrypsin, orosomucoid, C reactive protein, erythrocyte sedimentation rate, platelets, lymphocyte and polymorphonuclear cell counts, haematocrit, and faecal alpha 1-antitrypsin concentration. The distribution of these parameters was studied and transformation was used so that data matched the normal distribution closely. A weak but significant correlation (r = 0.32; p < 0.001) was found between clinical and endoscopic indices in the whole group of patients and this correlation seemed to be homogenous in various patient subgroups (clinically quiescent or active disease, pure colonic disease, untreated patients). Endoscopic or clinical indices were also found to be weakly linked with biological parameters (r < 0.50). Stepwise linear regression identified C reactive protein as predictive of the clinical index, and, successively, alpha 2-globulin, erythrocyte sedimentation rate, faecal alpha 1-antitrypsin, serum orosomucoid, and alpha 1-antitrypsin as predictive of the endoscopic index. Both predictions were poor--the biological variables accounting for only 22 and 44% respectively of the clinical and endoscopic index variations. In conclusion, Crohn's disease clinical activity seems to be virtually independent of the severity of the mucosal lesions and biological activity.

Adolescent↗

[Ultrasonic endoscopy of superficial epidermoid cancer of the esophagus].

Superficial squamous cell carcinomas of the oesophagus are defined as cancers confined to the mucosa or involving the submucosa but sparing the muscularis mucosae, with or without lymph node extension. Although lymph node involvement is rare (less than 5%) in tumours confined to the mucosa, it is frequent (30 to 45%) in tumours involving the submucosa, which have a prognosis similar to that of the usual obstructive tumours. Endoscopic ultrasonography is the most accurate examination (diagnostic accuracy greater than 95%) to distinguish between superficial and advanced cancers. The absence of visualization of the muscularis mucosae with the currently available transducers limits the decision-making value of such a distinction except in the case of flat tumours in which the absence of ultrasonographically detectable parietal thickening indicates the presence of a cancer confined to the mucosa, with an excellent prognosis.

Carcinoma, Squamous Cell↗

[Psoas abscess complicating Crohn's disease].

Psoas abscess were found in 6 cases among 166 patients with Crohn's disease between 1985 and 1989; in one case, it was the first sign of Crohn's disease. Diagnosis was usually difficult and should be suspected on the following signs: lower abdominal quadrant pain, psoitis, abdominal mass, sciatica or pain along the course of the femoral nerve. Diagnosis was confirmed in nearly all cases by computerized axial tomography. Effective therapy combines drainage and bowel resection.

Adolescent↗

[Chemoprophylaxis of Plasmodium falciparum malaria by a combination of 100 mg of chloroquine and 200 mg of proguanil per day in a zone III of chloroquine resistance (Gabon). Study of 431 French soldiers].

Incidence of P. falciparum malaria in french non-immune soldiers serving in Gabon for four months has increased from 21% in 1987 to 37% in 1988. Since 1989, in a first step, the personal protection measures were reinforced. Thereafter, the usual chemoprophylaxis (chloroquine 100 mg daily) was replaced by a daily association of chloroquine 100 mg and proguanil 200 mg. A 85% decrease of malaria incidence was observed in 431 soldiers. The effects of the personal protection strengthening and of the new chemoprophylaxis can be evaluated to be respectively responsible for 50% and 71% decrease. Among the secondary effects, gastric pain was the most frequent, but it was never a cause of chemoprophylaxis stopping. The mouth ulcer frequency was far lower than that elsewhere reported. No significant biological abnormalities could be related to the chloroquine-proguanil association.

Animals↗

[Percutaneous endoscopic gastrostomy. Indications and follow-up in 30 patients].

The indications and results of percutaneous endoscopic gastrostomy (PEG) were reviewed in 30 consecutive patients, most of whom had problems of deglutition secondary to the treatment of ENT neoplasia. The procedure was successful in all patients but some difficulty was encountered in 4 cases. There were no major complications or fatalities. The benign complications were all amenable to medical therapy and did not require ablation of the gastric tube. In general, PGE was well tolerated and an easy to use method of nutritional assistance, allowing most patients to gain weight. In the authors' experience, this technique has an important role to play in the nutritional assistance of patients with problems of deglutition due to neurological disease or ENT neoplasia. The relative innocuity of PEG gives it a great advantage over surgical gastrostomy.

Adult↗

[Percutaneous endoscopic gastrostomy. Indications and results in 31 patients].

Nutritional assistance was indicated in 31 patients with an ENT tumour at different stages of treatment and different stages of the disease. These patients presented with disorders of deglutition with false passages (68%), aspiration pneumonia (10%), dysphagia (35%) or denutrition (17%). We used an endoscopic percutaneous gastrotomy kit produced by the Bioser company (pull technique). In 29 patients, the tube was inserted under general anaesthesia in the operating theatre to prevent dyspnoea during introduction of the tube in these patients with alteration of the airway-gastrointestinal tract junction or because the tube was inserted at the beginning of anaesthesia for ENT surgery. The tube was able to be inserted in every case, with cardiac arrest in one patient who was effectively resuscitated without sequelae, two obstructions of the cuff requiring advancement of the tube with a bougie, 2 ruptures of the thread and one case of dyspnoea. Two patients subsequently developed a wound abscess which was drained and one patient required removal of the tube. Follow-up of the patients demonstrated the good tolerance of this tube which was maintained for an average of 2.9 +/- 0.5 months (0.1 to 9 months) without any major complications. 3 benign wound infections, 4 inflammatory reactions, 4 minimal leaks, 1 case of hyperthermia, 12 cases of abdominal distension and 2 cases of displacement of the tube were observed. The weight gain was equal to 4%. The authors believe that this technique of endoscopic gastrostomy should be preferred to surgical gastrostomy.

Adult↗

[Percutaneous endoscopic gastrostomy. Indications and follow-up in 52 patients].

A nutritional support was indicated in 52 patients, most of whom had deglutition problems linked with post-therapeutic after-effects of neoplasia of the ORL sphere. Assistance was possible in all the cases, with difficulty in 9 cases. There were only three major complication (two of which necessitated the removal of the tube) and no fatalities. Benign, more numerous complications were all medically curable and did not necessitate the removal of the tube. The follow-up of the patients showed remarkable tolerance to, and nonproblematic use of, the GPE tube as a nutritional aid leading, in the majority of cases, to a weight gain, even when ambulatory. Our experience suggests that this technique deserves a prime place as a nutritional aid for cases of deglutition problems, of neurological origin, and in ORL cancers. Its relative safety must undoubtedly make it preferable to the surgical technique.

Adult↗

Apparent total alpha1-antitrypsin deficiency: report of a case.

A 29-year-old female, with chronic renal failure and chronic bilateral emphysema, was admitted with severe uremia and septicemia secondary to multiple abscesses in the right kidney. Her condition improved after right nephrectomy. Pulmonary function studies showed marked obstructive and restrictive lung disease consistent witht the diagnosis of primary emphysema. On biochemical and histological examination, the liver was found to be normal. Alpha1-antitrypsin could not be demonstrated in the patient's serum at normal pH by any of the known techniques, but protein molecules with alpha1-antitrypsin antigencity were found at pH 4.8; this suggests a pH-dependent structural difference in alpha1-antitrypsin protein. Starch gel electrophoresis gave a multibanding pattern not previously described. A new form of apparent total alpha-1-antitrypsin deficiency is postulated.

Abscess↗

[Depigmentation for cosmetic purposes: prevalence and side-effects in a female population in Senegal].

BACKGROUND: Use of depigmenting agents by black women for cosmetic purposes is a long-standing practice. Most depigmenting agents contain topical steroids and hydroquinone. The purpose of this study was to clarify prevalence data on use of depigmenting agents in a female population in Senegal and to report the incidence and main features of adverse skin reactions in addition to possible associations with diabetes, hypertension and renal insufficiency. PATIENTS AND METHODS: A cross-sectional study was made in a representative sample of 147 hospitalized women aged from 15 to 60 years. The incidence of adverse skin reactions, diabetes, hypertension and serum creatinine in 41 women admitting use of depigmenting agents was compared to those found in 85 women who maintained they had never used depigmenting agents. Two patients who refused to participate in the study and 19 others who did use depigmenting products and had stopped their use for at least 3 months were excluded from the analysis. RESULTS: The prevalence of use of depigmenting agents was 27.9% (47/147). Adverse skin reactions were significantly more frequent among these patients. Effects observed were similar to those reported for prolonged use of topical steroids but also included periorbitary dyschromia, exogenous ochronosis, infectious dermatosis, and, in particular, extended dermatophytosis and necrotizing cellulitis, contact eczema, and certain hyperpigmentation when depigmenting agents were discontinued. Presence of relative hyperpigmentation of the dorsal phalanges identified use of depigmenting agents with a 100% specificity. Prevalence of diabetes and hypertension was significantly higher among the group of women using depigmenting agents (46.3% and 8.2%, versus 34.1% and 8.2% respectively). There was no difference for renal insufficiency. The risk increased independently of age depending on whether duration of use was less than 10 years or not with a relative risk that rose from 3.63 (1.2-10.47) to 6.47 (3.41-12.32) for diabetes and from 1.34 (0.45-3.96) to 2.65 (1.27-5.51) for hypertension, clearly suggesting a possible dose effect. DISCUSSION: The prevalence of use of depigmenting agents in this first published hospital series confirms the widespread nature of this phenomenon in Senegal. While certain patent skin signs are similar to those described in the literature, and excluding specific features related to the hospital setting, this is the first report of a dose-effect between use of depigmentation agents and diabetes and hypertension, probably via the effect of topical steroids.

Administration, Topical↗

Mycobacterium paratuberculosis and Mycobacterium avium subsp. silvaticum DNA cannot be detected by PCR in Crohn's disease tissue.

BACKGROUND: The etiology of Crohn's disease remains unknown. A putative mycobacterial cause of the disease is still controversial. AIMS: To assess the mycobacterial hypothesis in Crohn's disease using a polymerase chain reaction technique. PATIENTS AND METHODS: Nested polymerase chain reaction with primers on the 16S-rRNA coding region (16S-rDNA) and with primers specific both to the insertion sequences (IS) 900, and IS 901/902 were used to amplify Mycobacterium paratuberculosis or Mycobacterium avium subsp. silvaticum DNA in frozen endoscopic intestinal biopsies or surgical resection specimens from patients with Crohn's disease (n = 47: 25 endoscopic biopsies and 22 surgical resection samples, +/- lymph nodes), ulcerative colitis (n = 27), and non inflammatory bowel diseases (n = 20: colonic tumors and diverticulitis). Positive as well as negative controls were used throughout the study. RESULTS: All strains of Mycobacterium paratuberculosis and Mycobacterium avium subsp. silvaticum tested were positive for both primer systems. Of the 94 biopsies tested, 5 (2 Crohn's disease, 1 ulcerative colitis and 2 controls) were positive with the 16S-rDNA primers but did not correspond to Mycobacterium paratuberculosis or Mycobacterium avium subsp. silvaticum. None of the specimens was positive with the IS primers. CONCLUSION: These results do not support the hypothesis that Mycobacterium paratuberculosis, or Mycobacterium avium subsp. silvaticum play a role in Crohn's disease.

Adult↗