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D Benchimol

Publications and source records attributed to D Benchimol.

At least 37 records · Page 2Linked to original sources
PubMed2000

Detection of coronary stenoses by stress echocardiography using a previously implanted pacemaker for ventricular pacing: preliminary report of a new method.

BACKGROUND: The number of patients with pacemakers has been increasing and a large number of them will present with chest pain or symptoms suggesting angina pectoris. Myocardial ischemia and presence of coronary artery disease are difficult to detect and assess by noninvasive methods in patients with a pacemaker; the electrocardiogram (ECG) at rest and during exercise is usually very difficult to analyze in terms of ischemia or even presence of an acute myocardial infarction. HYPOTHESIS: To detect significant coronary stenosis in patients with previously implanted pacemakers, we tested a new stress echocardiography method using incremental ventricular pacing by already implanted pacemakers. METHODS: We studied prospectively 25 consecutive patients who underwent stress echocardiography with increasing ventricular pacing up to either 85% of the age-predicted maximal heart rate or chest pain. Positive tests were defined by new hypokinesia or worsening of a preexisting alteration in wall motion in at least two adjacent territories. All patients underwent coronary angiograms to define the presence and severity of coronary stenoses. RESULTS: Among the 25 tests, 11 (44%) were stopped for chest pain. 1 (4%) for moderate discomfort, 1 (4%) for a drop in blood pressure, and the target pacing rate was achieved in the tests of the remaining 12 patients (48%). There were no complications. Thirteen patients had significant stenoses. In 10 cases, stress echocardiography was a true positive test with respect to coronary angiography. There were 11 true negative, 1 false positive, and 3 false negative tests. The sensitivity was 77%, specificity was 90%, the positive predictive value was 91%, and the negative predictive value 79%. The accuracy was 84%. CONCLUSIONS: This new stress echocardiography method appears feasible, easy, safe, and effective for detection of significant coronary stenoses in patients with pacemakers.

Aged↗
PubMed2000

[Endometriosis of the rectus abdominis muscles].

The authors report three cases of endometriosis of the rectus abdominis muscle, presenting as a mass of the abdominal wall associated with pain during menstruation in women with a history of cesarean section. Treatment consisted in wide surgical resection followed by prosthetic abdominal wall repair in one recurrent case. Abdominal wall endometriosis is a rare disease that can be explained by grafting of endometrial cells to the abdominal wall during laparotomy for pelvic surgery, particularly cesarean section. Isolation of the abdominal wall during cesarean section and irrigation of the abdominal wall at the end of the operation are two theoretical measures designed to prevent endometrial cell engraftment. When abdominal wall endometriosis occurs, only radical surgical resection can prevent recurrence.

Abdominal Pain↗
PubMed2000

[Vaccination by suicide gene therapy against a model of hepatic metastasis from colon cancer in the rat].

UNLABELLED: Suicide gene therapy consists of transferring into tumor cells a viral or bacterial gene encoding for an enzyme which converts a non-toxic product into a lethal drug. STUDY AIM: To analyze the therapeutic potential of vaccination with tumor cells expressing the bacterial cytosine deaminase (CD) gene and 5-fluorocytosine (5-FC) treatment in a rat liver metastasis model. MATERIAL AND METHOD: We used a rat colon carcinoma cell line which, after subcapsular or intraportal injection in syngenic animals, generates single or multiple experimental liver metastases, respectively. We have shown that introduction of a vector expressing the CD gene in this colon carcinoma cell line results in 5-FC sensitivity (PRObCD). RESULTS: Intrahepatic subcapsular injection of PRObCD tumor cells, followed by 5-FC treatment, induces total regression of a wild-type tumor pre-established in the contralateral liver lobe in 45% of animals with a 96% decrease in mean volume (p < 0.0001), demonstrating the existence of a distant bystander effect. This vaccination significantly increased the survival of rats with single (log-rank p < 0.0001) or multiple (log-rank p = 0.01) liver metastasis CONCLUSIONS: These results suggest that suicide gene-modified tumor cells can act as potent therapeutic vaccines against liver metastasis from colon carcinoma.

Animals↗
PubMed2000

Regression of experimental liver tumor after distant intra-hepatic injection of cytosine deaminase-expressing tumor cells and 5-fluorocytosine treatment.

Cytosine deaminase (CD) gene of E. coli converts the non-toxic compound 5-fluorocytosine (5-FC) into 5-fluorouracil. We have introduced a vector expressing the CD gene in a rat colon carcinoma cell line. Expression of the CD gene confers 5-FC sensitivity to these cells in vitro and in vivo. In a bifocal model consisting in a simultaneous engrafment of a CD+ tumor on one lobe of the liver and a wild-type parental tumor on the opposite lobe, treatment with 5-FC results in regression of both type of tumors, indicating the existence of a distant bystander effect.

Animals↗
PubMed1999

[The natural history and complications of esophageal cancer].

Squamous cell carcinoma of the oesophagus has a poor prognosis, owing in part to the compromised status of the patients. Early oesophageal cancer is rarely diagnosed, even if its endoscopic aspects are well known. From the mucosa, the disease progresses step by step, and also via the submucosa. Furthermore, multiple locations are not uncommon. Bulky tumours progressively obstruct the oesophageal lumen while infiltrative tumours invade the oesophageal layers, and then the perioesophageal fat and the mediastinal organs. Involvement of mediastinal, cervical and abdominal lymph nodes occurs early. Distant metastases occur later. Complications are mainly due to the locoregional spread of the disease, leading to death.

Adipose Tissue↗
PubMed1999

[Adenocarcinoma in Barrett's esophagus. A study of 28 resected cases].

STUDY AIM: The aim of this retrospective study was to report a series of 28 patients with adenocarcinoma (ADK) arising in Barrett's esophagus (BE), treated by esophagectomy. PATIENTS AND METHODS: From 1992 to 1998, 28 patients were operated on for ADK in BE. There were 27 men and one woman (mean age: 65 years) classified as ASA I (n = 2), ASA II (n = 15) and ASA III (n = 11). Eighteen patients had a long story of gastro-esophageal reflux disease which required surgical repair in five of them. Dysphagia was the main symptom (n = 19). Surgical procedures included 15 Ivor Lewis operations, nine esophagectomies without thoracotomy and four esophagogastrectomies by the left thoracic approach. RESULTS: Pathological examination of the specimens showed an EBO with adenocarcinoma (n = 27) and a high grade dysplasia (n = 1). Among five patients with a previously known BE, three under endoscopic surveillance had high grade dysplasia (n = 1) and limited T1 tumor (n = 2), while the other two patients without surveillance developed an invasive tumor (T3N1). There were three postoperative deaths (mortality rate: 10%), all arising from pulmonary failure. Median survival was 16.6 months. All patients resumed a normal diet. The actuarial survival rates were 63%, 42% and 15.2% respectively at 1, 2 and 4 years. A multivariate analysis could identify 3 prognostic factors: ASA score previously known BE under surveillance, length of BE. CONCLUSION: Adenocarcinoma arising in BE is very often diagnosed too late. Patients with high risk BE require an endoscopic survey. High grade dysplasia detected in two successive examinations by two different pathologists may require prophylactic esophagectomy, but local endoscopic management presently under evaluation could be efficient in the future.

Actuarial Analysis↗
PubMed1998

[Peritoneal benign polycystic mesothelioma].

BACKGROUND: Benign multicystic peritoneal mesothelioma (BMPM) is an uncommon condition. CASE REPORT: We observed a typical case of BMPM occurring in a 57-year-old man who presented with a painful mass of the lower right quadrant. The pathology using immunostaining gave the diagnosis. DISCUSSION: The diagnosis of BMPM can be suspected on the basis of imaging findings, but is usually confirmed by pathology. The only treatment for BMPM is surgical resection. Prognosis is good despite frequent recurrences. Two main hypotheses based on etiopathology can be discussed: does BMPM consist of a mesothelioma proliferative and reactional lesion or is it a real mesothelioma tumor?

Humans↗
PubMed1998

Treatment of hepatic metastases of colorectal cancer by electrochemotherapy: an experimental study in the rat.

BACKGROUND: Electrochemotherapy, which consist of local or systemic administration of a cytotoxic agent followed by application of electric pulses to a tumor, has proved effective for various types of tumors in animals and for cutaneous and head and neck cancers in human beings. This is the first study to investigate the efficacy of electrochemotherapy for treatment of hepatic metastases of colorectal cancer in the rat. METHODS: After induction of a solitary hepatic metastasis in 36 male BDIX rats, the animals were randomized to one of four groups: B-E-(no treatment), B+E-(intratumoral bleomycin), B-E+ (application of electric pulses to the tumor), and B+E+ (electrochemotherapy: intratumoral bleomycin followed by application of electric pulses). RESULTS: Groups B-E and B-E+ had no tumor response. Group B+E had one partial response. Group B+E+ had seven partial responses and two complete responses. The difference in terms of response between group B+E+ and the other three groups was statistically significant (P < .05). Comparison of the mean posttherapy tumor volumes (B-E-, 50.6 mm3; B+E-, 58.7 mm3; B-E+, 46 mm3; and B+E+, 5.65 mm3) revealed a significantly smaller residual tumor in group B+E+ than in the other three groups (P < .05). CONCLUSIONS: Electrochemotherapy is an effective means to reduce the volume of hepatic metastases of colorectal cancer in the rat. Additional research is required to determine the optimum treatment duration, dose effects, volume of tumor that can be treated by electrochemotherapy, and impact on survival. Such experimental studies are indispensable prerequisites for clinical trials.

Animals↗
PubMed1997

Restenosis or rapid progression in non-dilated sites are not predictors of late spontaneous coronary events.

The present study was designed to assess the prognostic value of clinical and angiographic factors, and especially restenosis or rapid progression in non-dilated sites, on major spontaneous coronary events at long-term follow-up after a first successful coronary angioplasty performed for angina pectoris. A second aim was to assess the prognostic factors and especially restenosis in asymptomatic patients after angioplasty. The first 352 consecutive patients undergoing a successful coronary angioplasty were selected and followed-up. The following variables: age, sex, unstable angina, previous myocardial infarction, diabetes, hypercholesterolemia, tobacco consumption, hypertension, fibrinogen, coronary extent, single or multiple dilatation, restenosis, new progression, clinical deterioration of anginal status just before angiographic restudy or asymptomatic status were subjected to a stepwise regression analysis. Restenosis (a loss of 30% in diameter and/or a return to a >50% stenosis) and progression in non-dilated segments (a 20% reduction in diameter) were assessed by a computer-assisted method. Cardiac death, new myocardial infarction or new unstable angina, at long-term follow-up after angiographic restudy, were regarded as spontaneous coronary events and pooled in a single dependent variable. Thus 41 patients had a coronary event. In the overall population, clinical deterioration of anginal status (p<0.001, relative risk: 3.65) and fibrinogen (p<0.05, relative risk: 1.03) were independent predictors of spontaneous coronary events. Restenosis or new progression were not predictors. In asymptomatic patients (n=187), fibrinogen (p<0.01, relative risk=1.06) was the only predictor and restenosis was not an independent predictor of spontaneous coronary events. The best predictor of spontaneous coronary events at long-term follow-up after a first successful coronary angioplasty is clinical deterioration in anginal status in the months following the procedure. Restenosis does not appear as an independent predictor. Rapid progression observed in non-dilated sites is not an important prognostic factor.

Adult↗
PubMed1996

Technique for the repair of diaphragmatic eventration.

In contrast to the large thoracotomy incisions required by standard surgical techniques for repair of diaphragmatic eventration, the procedure we developed can be performed by video-assisted thoracoscopy, thus offering patients the advantages of a minimally invasive operation. Using two superposed series of transverse back-and-forth continuous sutures, the diaphragm is invaginated, then stretched. The first suture line holds the diaphragm down and maintains the excess within the abdomen; the second suture line places the desired tension on the diaphragmatic dome. Successful repair of 3 cases by this technique is described.

Adult↗
PubMed1996

[Results of surgical treatment of complicated paraesophageal hernias].

From January 1979 to May 1995, 18 patients (4 men, 14 women) with a mean age of 75.4 +/- 12.5 yr underwent surgery for a complicated paraesophageal hiatus hernia. In 5 patients, the complication was the first sign of the diagnosis. Thirteen patients had a history of digestive, respiratory, or cardiac symptoms (mean duration of symptoms 74 mo.; range 2-240 mo.); 9 of them were aware that they had a hiatus hernia. Ten patients presented with acute obstruction (associated with a perforation in 1 case, jaundice in 1 case, and righy lower lobe pneumonia in 1 case). Hemorrhage occurred in 6 patients (hematemesis 4 cases, melena 2 cases). One patient had a perforation and another had an abscess of the lower right lobe. Surgery was performed via a transabdominal approach in all cases (5 times as an emergency, 12 times as a delayed emergency procedure, and once as an elective procedure). The procedure was delayed in 13 cases because of successful nasogastric decompression. All patients underwent reintegration of the stomach, diaphragmatic repair and gastropexy. An antireflux procedure was performed in 14 cases. Seven patients had an ancillary procedure (including one splenectomy following decapsulation). There were no postoperative deaths. Two patients who underwent emergency surgery developed a benign complication. The outcome of 17 patients is known; none of them developed a recurrence. One patient who did not undergo an antireflux procedure presented with gastroesophageal reflux; another experienced pain during eructation. In conclusion, nearly two-thirds of all patients who present with an acute complication can benefit from medical preparation before surgery, a strategy that improves results.

Aged↗
PubMed1996

[Acute pancreatitis treated in a surgery ward. Apropos of 57 cases].

The aim of this study was to examine the results of a policy in the treatment of acute pancreatitis (AP): initial abstention, management in intensive care unit, surgery in cases of complication (infection and/or failure of medical treatment). The modalities of the surgical treatment were guided by CT scan findings: transperitoneal approach for diffuse lesions, posterior approach for localized lesions. From 1986 to 1994, 57 patients (32 males, 25 females, mean age 59.2 years) were referred to our department for AP. Etiology was gallstones in 29 cases, alcohol in 14 cases (Ranson < 3), moderate in 27 cases (Ranson < or = 5) and serious in 12 cases (Ranson > or = 6). According to the initial CT scan findings (56 cases), 9 patients were classified grade A, 11 grade B, 13 grade C, 8 grade D ans 15 grade E. Thirty eight patients were managed conservatively (mean Ranson stage 3.3), while 19 patients underwent surgical treatment (mean Ranson stage 4.6), in emergency for misdiagnosis (4 cases), or secondarily because of failure of medical management (15 cases). Surgery consisted in necrosectomy with active drainage in 13 cases and drainage alone in 6 cases. Associated maneuvers included: cholecystectomy in 8 cases, cholecystostomy in 2 cases, jejunostomy in 7 cases and colic resection for necrosis in 3 cases. Two patients (5%) managed conservatively died (multiple organ failure and cardiac insufficiency) while 4 patients (21%: NS) who underwent surgery died (2 multiple organ failures, 1 septic shock, 1 myocardic infarction). Mortality was correlated with the Ranson score: 42% for serious AP, 3.7% for moderate AP and nil for mild AP (p < 0.01). It was not correlated with CT scan grade, the onset or the type of operation. These results allow us to conclude that surgical treatment should be indicated only in cases of failure of conservative management, the best indication being uncontrolled sepsis. In this situation, active drainage provides good results since only one sepsis recurred among the 14 patients who underwent this procedure.

Acute Disease↗
PubMed1995

Predictive value of hemostatic factors for sudden death in patients with stable angina pectoris.

To assess hemostatic risk factors for sudden death in patients with stable angina, 323 consecutive patients were recruited prospectively. Patients with clinical heart failure or recent myocardial infarction were excluded. The following clinical variables were recorded: age, gender, smoking habits, hypertension, previous myocardial infarction, left ventricular hypertrophy, and severe ventricular arrhythmia. Angiographic variables included coronary extent, assessed from Jenkins' and mean atherosclerotic scores, and left ventricular ejection fraction. Lipid variables included total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoproteins A-I and B. Hemostatic factors included fibrinogen, fibrinopeptide A, antithrombin III, factor VIII antigen, factor VIII coagulant, protein C, plasminogen, alpha 2 antiplasmin, euglobulin clot lysis time, tissue plasminogen activator before and after venous occlusion, and plasminogen activator inhibitor. There were 34 deaths, 19 of which were sudden during the follow-up period (60 +/- 17 months). The association between each variable and the risk of sudden death was assessed by calculating the relative risk with the Cox univariate model. All significant predictors from the univariate analysis were then incorporated in a Cox multivariate model to select the independent predictors of sudden death. The independent predictors of sudden death were left ventricular hypertrophy (p < 0.04), lower left ventricular ejection fraction (p < 0.04), and shorter euglobulin clot lysis time after venous occlusion (p < 0.02), whereas fibrinogen (p < 0.07) and Jenkins' score (p < 0.08) were borderline. Determination of hemostatic variables, especially those pertaining to dynamic fibrinolysis, may thus be of value in assessing risk of sudden death.

Analysis of Variance↗
PubMed1995

Progression of coronary artery disease in non-dilated sites in the months following balloon angioplasty: time-dependent relation with restenosis.

There is scant information on the progression of coronary artery disease in non-dilated sites in the months following percutaneous transluminal coronary angioplasty (PTCA) or on its relationship with restenosis. To assess the incidence of this progression and its relationship with restenosis at various times after PTCA, the authors selected 371 consecutive patients who had undergone a first successful PTCA for angina on native coronaries followed by a repeat angiographic study. The angiograms were analysed by a computer-assisted method; progression was defined as a 20% decrease in diameter and restenosis as a 30% decrease in diameter or a return to > 50% stenosis. The relationship between progression and restenosis was analysed in the whole population and then, using the Mantel-Haenszel chi-square test, in two subgroups: patients with a stable clinical state, who were restudied routinely and those whose worsened state had prompted repeat angiography. The relationship was assessed at different times between angioplasty and the repeat angiography. Progression was observed in 80 patients (22%) and restenosis in 155 patients (42%). There was a highly significant relationship between progression and restenosis in the total population (chi 2 = 26.4, odds ratio = 3.9 and P < 0.0003) and in the group of patients that were routinely restudied (chi 2 = 31.6, odds ratio = 5.3 and P < 0.0001), but not in the group of patients in whom restudy was performed because of clinical worsening (chi 2 = 0.13, odds ratio = 1.5 and P = NS). With respect to the length of follow-up, in the total population the relationship was significant only at 6 and 7 months (P < 0.0001), and in the group receiving a routine restudy only at 4-5 and 6-7 months (P < 0.001). Progression in non-dilated sites appeared to be strongly and transiently linked with restenosis, suggesting that PTCA may enhance both restenosis and progression over a short period.

Aged↗
PubMed1995

[Vesico-sigmoidal fistulas of diverticular origin].

From 1984 to 1993, 11 patients (7 men and 4 women, mean aged 70 years) underwent surgical procedure for sigmoido-vesical fistula due to diverticulitis. Fecaluria and/or pneumaturia was present in 10 patients. The diagnosis of sigmoido-vesical fistula due to diverticulitis was confirmed by urologic and colonic investigations. All patients underwent surgical treatment. One patient underwent creation of a diverting colostomy alone because of a poor general status. Definitive surgical correction of the fistula with resection of the diverticular colon was attempted in the remaining 10 patients, including colo-rectal anastomosis. A temporary diverting colostomy was performed in 5 cases. There was no post operative death. One small wound infection occurred. All the diverting colostomies have been closed, meanly 2 months after the operation. Concerning long-term results, 3 patients died from an independant reason. All the other patients are alive and asymptomatic from the urologic as well as the digestive point of view. Based on these results, we advocate single stage repair, including correction of the fistula and resection of the diverticular colon with colo rectal anastomosis, in cases of good local and general conditions.

Aged↗