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C Liguory

Publications and source records attributed to C Liguory.

At least 19 recordsLinked to original sources
PubMed1992

Management of malignant hilar biliary obstruction by endoscopy. Results and prognostic factors.

Between January 1983 and December 1987, 103 patients who had hilar biliary obstruction (59 men, 44 women, median age 73 years) were referred to our institution. The causes of hilar biliary obstruction were carcinoma of the bile ducts (55), hepatic metastases or hepatocellular carcinoma (30), and carcinoma of the gallbladder (18). When endoscopic retrograde cholangiography was performed, the stricture was classified as type I in 28%, type II in 41%, and type III in 31% of the patients. In 92 patients, we tried to insert endoscopically a 10, 11, or 12 F Amsterdam type prosthesis; it proved possible in 66 (74%), and the prosthesis proved functional without further procedure in 49 cases (53%); no combined percutaneous and endoscopic method was used. At death or discharge, 45 patients (49%) had a successful drainage. Cholangitis was the main procedure-related complication and occurred in 25 patients. The 30-day mortality was 43%. Results varied according to type of stenosis: successful drainage was performed in 15% of the patients with type III stenosis, compared with 86% when the stenosis was of type I. Under a multivariate analysis the independent prognostic factors of 30-day mortality were: (1) development of infectious complications after endoscopic attempt at drainage (P less than 0.0001), and (2) absence of successful drainage (P less than 0.0001). In conclusion, endoscopic endoprosthesis placement allows a sufficient drainage in 53% of the cases. In type III stenosis, the high rate of 30-day mortality leads us the conclusion that endoscopic drainage must be avoided.

Adult↗
PubMed1992

Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis.

Juxtapapillary diverticula are often associated with biliary lithiasis. The aim of this study was to compare the prevalence of juxtapapillary diverticula in choledocholithiasis and in cholecystolithiasis without common bile duct stones. The results of 520 consecutive retrograde cholangiographies were retrospectively analysed. The prevalence of juxtapapillary diverticula was higher in patients with biliary lithiasis than in patients without: 26.0% vs 10.5% (p less than 0.001). However, juxtapapillary diverticula were more frequently encountered in patients with choledocholithiasis than in those with gallbladder lithiasis or previous cholecystectomy and a stone-free common bile duct: 40.0% vs 10.2% (p less than 0.001). There was no significant difference between the patients with cholecystolithiasis alone and those without biliary lithiasis. Among the patients with previous cholecystectomy or with gallbladder lithiasis, common bile duct stones were more frequently found in patients with juxtapapillary diverticula than in those without: 80.3% vs 40.6% (p less than 0.001). These data suggest that juxtapapillary diverticula are associated only with choledocholithiasis and not with gallbladder lithiasis.

Aged↗
PubMed1992

[Extracorporeal lithotripsy in the treatment of common bile duct calculi].

Thirty-three patients with common bile duct stones which could not be extracted by routine endoscopic measures were treated with extracorporeal lithotripsy. Two electrohydraulic lithotripters were used: Dornier HM3 and Technomed Sonolith 3000 using fluoroscopy and ultrasonography, respectively, for stone localisation. Twenty-nine patients were treated with only one session and four patients in two sessions. Fragmentation of stones was obtained in 29 patients (88 p. 100) and complete bile duct clearence in 26 patients (79 p. 100). The fragments passes spontaneously through the papilla in 7 cases; in 19 cases complete removal of fragments was achieved with a Dormia basket (16 cases) or after mechanical lithotripsy (3 cases). There were no significant differences in successful fragmentation rates between the two lithotriters. No serious adverse effects or mortality were observed within the 30 days following treatment. In conclusion, extracorporeal lithotripsy is an effective and safe method for the treatment of bile duct stones when, after sphincterotomy, routine endoscopic measures have failed.

Adult↗
PubMed1979

[Upper gastrointestinal haemorrhage in the patients aged over 65 years. The contribution of endoscopy (author's transl)].

One hundred and eighty four patients aged over 65 years and hospitalised for gastrointestinal haemorrhage of high origin underwent emergency oesophago-gastro-duodenoscopy. It was thereby possible to make an aetiological diagnosis in 94.5% of cases. The study demonstrated certain special features: the preponderance of acute gastro-duodenal lesions, possibly explained by the high consumption of gastrotoxic drugs in the elderly subject; the relative frequency of oesophagitis (11%), one out of two cases being responsible for the bleeding; the discovery of a hiatal hernia in 59 patients (1/3 of cases), 25% of them bleeding from a lesion directly related to the latter. Bleeding was in large quantity in 57% of cases. Mortality, which was quite high (17%) appeared to be more related to the underlying general condition than to the haemorrhage itself. Endoscopy gave rise to complications in 8 patients, including 3 who died.

Aged↗
PubMed1979

[Endoscopic sphincterotomy. 362 cases (author's transl)].

In addition to its diagnostic value, endoscopic catheterisation of the papilla may be used for the therapeutic purpose of diathermy incision of the papilla and of the intraduodenal portion of the common bile duct. Endoscopic sphincterotomy of this type has been essentially used in choletithiasis and in particular for residual lithiasis. These indications may be widened to include benign stenosis of the sphincter of Oddi, tumours of the ampulla of Vater or even acute pancreatitis. In a total of 362 cases, sphincterotomy was successful in 347 patients, it being possible to remove the calculi present in 279 of the 309 patients treated with success for lithiasis of the common bile duct. Complications occur in approximately 10% of cases, being fatal in 1.4% of cases. These are essentially related to bleeding. Retrospective comparison of mortality after surgical operation and after endoscopic sphincterotomy is in favour of the latter, provided the technique employed is perfect and the indication clearly defined. Performed without general anaesthesia, endoscopic sphincterotomy is above all indicated in the elderly and/or those with other major pathology who can be successfully treated with reduced risk in 93% of cases, as shown by the 140 personal cases of the authors cured between 6 and 36 months ago.

Acute Disease↗
PubMed1978

[Intra-hepatic gall bladder complicated by post-operative stones in the common bile duct. The value of endoscopic sphincterotomy (author's transl)].

Two cases of migration of stones in the common bile duct following operation of cholecystitis secondary to cholelithiasis in an intra-hepatic gall bladder are reported. The authors emphasise the difficulties of the operation. When it was necessary to limit surgery to external drainage, migration of stones to the common duct from the gall bladder left in place is possible. In the two cases presented, endoscopic sphincterotomy resulted in the early expulsion of the calculi and permanent drainage of the common bile duct, a presumptive guarantee against the complications of new migrations.

Aged↗
PubMed1976

[Wirsung's duct and chronic pancreatitis. Changes in the morphology of the pancreatic ducts after pancreatic duct shunts. 23 cases followed-up].

The authors study in chronic pancreatitis the morphology of Wirsung's duct in 31 patients who had undergone repeated operations, 23 of them were submitted in a first stage to an anastomosis between the pancreatic duct and the digestive tract. The main causes of failure were obstructions of the anastomosis, biliary complications and continuation of the pancreatic disease. The difference in prognosis between pancreatitis with a dilated pancreatic duct, and those with a filiform duct, is perhaps due to lesions of different histological appearance and course. The best results were obtained in patients able to give up alcohol and in whom it was possible to carry out a broader anastomosis on a dilated and unobstructed pancreatic duct.

Adult↗
PubMed1975

[Pancreatic biologic reactions after Wirsung opacification under duodenoscopy. Preventive action of Frey's inhibitor (67 cases)].

After retrograde opacification of be pancreatic ducts by duodenoscopy, pancreatic biologic reactions have been studied, especially by amylasemia and lipasemia measures. These biologic reactions have been all the more frequent and intense as Wirsung's duct and its tributaries filling have been important. Frey's inhibitor had a proptious action on these biologic reactions; therefore, it may be used as a preventive treatment.

Amylases↗