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Biomedical subjects

D Bonnel

Publications and source records attributed to D Bonnel.

At least 19 recordsLinked to original sources
PubMed2000

Percutaneous incision of stenotic uroenteric anastomoses with a cutting balloon catheter: long-term results.

PURPOSE: To describe the technique and results of incision of strictures in anastomotic urinary diversions with a commercially available cutting balloon catheter. MATERIALS AND METHODS: Thirty-seven stenoses were treated in 32 patients. Most (28 [88%]) of the patients had undergone surgery for bladder cancer 17.7 months +/- 17.4 (SD) (range, 3-72 months) before incision. Thirteen patients had undergone ileal conduit diversion, and nineteen had undergone enterocystoplasty. All stenoses were shorter than 3 cm. The presence of adjacent ileal loops and/or iliac vessels was assessed with computed tomography before incision. The cutting wire was oriented anteriorly or anterolaterally, and the balloon was inflated with diluted contrast material during the incision. A Kaplan-Meier survival curve was constructed to illustrate the success rates over time. RESULTS: No major complications occurred. Twelve (32%) stenoses recurred in nine patients 15 months +/- 10 (range, 6-36 months) after stent removal; the failure rate was 53% (eight of 15 stenoses) for ileal conduits and 18% (four of 22 stenoses) for enterocystoplasties. Late failure (>12 months) was observed in four patients. The patency of the other 25 stenoses (23 patients) was checked 25 months +/- 11 after stent removal (range, 5-43 months). The actuarial patency rate was 77% at 1 year, 68% at 2 years, and 62% at 3 years. CONCLUSION: Cutting balloon incision is a safe and simple alternative to surgery, particularly when the urinary diversion is enterocystoplasty.

Actuarial Analysis↗
PubMed1994

[Large calculi of the common bile duct. Value of lithotripsy].

Certain stones need to be fragmented before being extracted via endoscopic sphincterotomy (ES). From April 1988 to December 1991, extracorporeal lithotripsy was used in this indication in 28 patients (22 females, 6 males) with a mean age of 77 +/- 20 years, using an ultrasound-guided electrohydraulic lithotriptor. Stone detection was performed after perfusion of the nasogastric tube and was easy in 20 cases (71%), difficult in 6 cases (22%) and impossible in 2 cases (7%), which could not be treated by this method. The patients had an average of 1.4 +/- 0.9 stones measuring 19.6 +/- 8 mm and received an average of 2.480 +/- 580 shock waves in a single session for 24 patients and in two sessions for 2 patients. Radiologically obvious fragmentation was achieved in 11 out of 26 cases (42%) and was found to be effective at a further extraction attempt in 4 other cases. Complete clearance of the common bile duct was achieved in 15 cases (57.7%). The size of the stones (> or < 20 mm) and the solitary or multiple nature of the stones did not significantly influence the fragmentation results. No complication related to the technique was observed apart from the constant development of cutaneous petechiae. An improvement in the power of the generator and the use of fluoroscopic rather than ultrasonographic guidance should allow an improvement of these results in the future. Because of its safety, this lithotripsy method can be proposed following failure of mechanical lithotripsy.

Adult↗
PubMed1993

[Palliative treatment by endoprosthesis of icterus caused by distal biliary tumoral obstruction].

Between March 1982 and December 1987, 466 patients (256 women, 210 men, mean age 73 years) with tumor obstruction of the common bile duct were referred to our department. The causes of obstruction were carcinoma of the pancreas (298 patients), carcinoma of the ampulla of Vater (32 patients) and carcinoma of the common bile duct (136 patients). Endoscopical insertion of a biliary prosthesis was initially possible in 377 patients (81%). In case of failure, patients were referred to the radiologist for percutaneous drainage. Successful drainage was obtained in 58 patients with an overall success rate of 93% (435 patients). Endoscopic replacement was necessary in 170 cases for 114 patients and was successful in 155 (91%). Pruritus was relieved in 89% of the patients. Serum bilirubin levels decreased more than 75% after initial endoscopic endoprosthesis, repeated endoscopic endoprosthesis and percutaneous prosthesis insertion in 80%, 79%, and 62% of the patients, respectively. Short term complications of endoscopic endoprosthesis occurred in 28% of patients with a mortality rate of 8%. Percutaneous prosthesis complications occurred in 33% of patients with a mortality rate of 11%. In the long term, cholangitis was the main complication and occurred in 27% of patients with a delay of 103 +/- 105 days. Intestinal obstruction was observed in 7% of patients. The average life expectancy of endoscopic endoprosthesis and percutaneous prosthesis was 109 +/- 157 and 92 +/- 101 days, respectively. The average life expectancy of patients was 163 +/- 224 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
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

Fluoroscopically guided percutaneous transrenal electroincision of ureterointestinal anastomotic strictures.

A new technique for electroincision of a strictured ureterointestinal anastomosis is described that uses a sphincterotome and high frequency current. After placement of a percutaneous nephrostomy tube a 7F "wire guided" sphincterotome was placed into the stenosis. The cutting wire was then deflected while cutting current was applied intermittently. Injection of contrast medium through the papillotome probe assessed the depth of the incision. A 10 mm. angioplasty balloon was inflated at low pressure to verify that the anastomosis had been incised to a depth of 1 cm. The anastomosis was then stented for 8 weeks with an 18F stent. The operative time did not exceed 45 minutes. A total of 9 stenoses was treated in 7 patients: 4 were ileal conduit diversions and 5 were enterocystoplasties. No immediate complication was observed. In 1 case a small urinoma was surgically drained at removal of the stent. Six stenoses are patent with 2, 3, 4, 4, 10 and 13 months of followup after removal of the stent. One patient died of bladder tumor metastases during the stenting period and 1 with bilateral incision still has a stent. The technique can be performed without major complication (bleeding or digestive fistula). Long-term results remain to be assessed.

Constriction, Pathologic↗
PubMed1992

[Color doppler echography in the exploration of vasculogenic impotence].

102 patients with suspected vasculogenic impotence were evaluated with color doppler sonography. Measurement of normal systolic and diastolic velocities were obtained from the cavernosal arteries of patients responding by a full erection after intra-cavernosal injection of 20 mg of Papaverine. A correlation with cavernosometry was obtained in 61 patients and with selective internal pudendal arteriography in 11. The 10 patients with abnormal arteriograms had a systolic velocity < 25 cm/sec. 13 out of the 15 patients with an end diastolic velocity > 5 cm/sec had a venous leak defined by a maintenance flow rate of erection during cavernosometry > 25 ml/mn. End diastolic velocity is an excellent index of the function of the veno-occlusive system, provided the systolic velocity remains at a normal value. In case of arterial insufficiency, a diastolic flow < 5 cm/sec is of no value and cavernometry is mandatory to detect a mixed arterio-venous impotence. The addition of color doppler sonography permitted a more rapid detection of vessels and an easily reproducible measurement of velocities which makes color doppler sonography an excellent screening test for examining patients with potential vasculogenic impotence.

Adult↗
PubMed1991

[Endoscopic retrograde cholangiopancreatography and biliary prosthesis].

Endoscopic retrograde cholangio-pancreatography (ERCP) confirms the diagnosis of obstructive jaundice and sometimes provides the histological proof that the stenosis is due to cancer. Palliative treatment of biliary and pancreatic cancers is indicated when the extension of the tumour is such that it precludes any oncologically satisfactory excision, in patients at high operative risk, when jaundice recurs after surgery and in cases of biliary metastases from distant cancers. Cancers located below the hilum are usually easily treated by endoscopic insertion of a biliary stent, whereas hilar cancers extending to the bifurcation often require combined endoscopic and percutaneous techniques to drain all liver segments. The most frequent of early complications of biliary stents is cholangitis, notably in hilar cancers. Late complications, notably obstruction of the stent, can be reduced by using expandable metal stents.

Biliary Tract Neoplasms↗
PubMed1991

[Long-term results of angioplasty balloon dilatation of stenosed uretero-digestive anastomoses. Effect of prolonged pattern with large caliber prosthesis].

UNLABELLED: 16 strictured uretero enteric anastomoses were dilated and stented for 4 months with a large size stent (18F in fifteen cases and 14F in one case). All the patients had undergone a radical cystoprostactectomy, had received radiotherapy prior to surgery. The length of the stenosis did not exceed 3 cm in all cases. All the stenoses occurred within 2 years following the removal all of the stent. RESULTS: 6 cases (37%), have a patent anastomosis, 18 to 36 months following removal of the stent. Most of the recurrences occurred within six months following removal of the stent. We recommend a long term stenting with a large size stent to obtain long term patency of dilated anastomotic strictures.

Anastomosis, Surgical↗
PubMed1991

Endoscopic treatment of postoperative biliary fistulae.

Postoperative biliary fistulae are difficult to manage, particularly in the face of obstruction or malignancy. We used endoscopic sphincterotomy or endoprosthesis placement to aide fistula closure in 52 patients with postoperative biliary fistulae. Thirty-seven patients with a fistula were treated with endoscopic sphincterotomy alone. Twenty-four of these 37 patients had a history of lithiasis; 21 patients were treated successfully by endoscopic sphincterotomy alone. The fistula closed in 2.4 +/- 1.6 days. Among the other 13 patients without history of stone disease, the fistula closed in seven cases (54%), 8.4 +/- 2 days after endoscopic treatment. Three patients ultimately required surgical intervention. In 15 patients an attempt was made to pass a 10F endoprosthesis above the fistula. Among the eight patients with successful prosthesis insertion, the fistula healed in six patients (75%). In the seven patients in whom a prosthesis could not be passed endoscopically, the percutaneous transhepatic approach was used. Surgical treatment (hepaticojejunal anastomosis) was ultimately required in two of these seven patients. Sphincterotomy alone is the preferred treatment for biliary fistulae-complicating surgery for gallstone disease. Alternatively, when a fistula is large, endoscopic placement of a prosthesis can be proposed as the first treatment. In cases of endoscopic failure, placement of a prosthesis through the percutaneous transhepatic approach is a useful alternative, particularly when the fistula source is located in the intrahepatic biliary tract.

Biliary Fistula↗
PubMed1991

[Endoscopic and transhepatic intubation of malignant bile duct strictures for postoperative jaundice].

Out of 625 patients referred for stenting for a malignant stricture of the biliary tract, 97 (15.8%) had undergone previous surgery. Resection had been performed in 43 cases, by-pass in 15, surgical stenting in 11, laparotomy in 28. The stricture was located in the porta hepatis in 48 patients (49.5%) in the middle common bile duct (CBD) in 47 (48.5%) and juxtapapillary in 2 (2%). Endoscopic retrograde transhepatic stenting was successful in 51 patients (52.5%). Percutaneous transhepatic stenting was successful in 41 cases out of 46 (85%) and in 5 cases, only external drainage was possible. A 75% reduction in serum bilirubin was observed in 78 patients (81.5%) and normalization was observed in 66 (90%) who survived more than one month. The complication rate was 31.3% in the endoscopic group and 47.7% in the percutaneous transhepatic group, with a mortality related to early complications of 9.8% and 19.6% respectively. The higher complication rate of transhepatic stenting is at least partially related to an unfavourable selection of patients in this group: failures of endoscopic stenting, high frequency of hilar strictures. The mortality at D 30 was 24%, significantly higher in hilar strictures than in middle CBD strictures (p less than 0.02). A late obstruction of the stent occurred in 43 patients (58%) after an interval of 103 +/- 52 days, and endoscopic retreatment was possible in 65% of cases. The median survival was 153 days in subhilar strictures and 104 days in hilar strictures. These results justify considering the possibility of palliative stenting after failure of a surgical treatment especially in peri-ampullary and middle CBD strictures.

Aged↗
PubMed1991

[Use of papillotome for antegrade treatment of ureteral stenoses and uretero-ileal anastomotic strictures under radioscopic control. Experimental study in dogs and clinical application].

A new technique of electro-incision of ureteral stenoses and strictured uretero-enteric anastomoses is presented. Incision is performed with a papillotome, routinely used to achieve endoscopic retrograde sphincterotomy of the duodenal papilla. Group I: 7 ureteral stenoses were performed, on a dog model after surgical ligation of the lumbar ureter. Ten days later, through a percutaneous approach, the papillotome was placed through the stenosis, deflected, and cutting current was applied to incise the stenosis. The IVP performed one month later showed disappearance of the stenosis in 4 cases, a residual stenosis without obstacle in 2 cases and a residual stenosis with obstacle in one case. Group II: 7 strictured uretero-enteric anastomoses on 6 patients. After placement of a percutaneous nephrostomy, a wire guided papillotome was placed into the stenosis. Cutting current was then applied to cut the stenosis. A 18 F ureteral stent was subsequently placed for 8 weeks. Two patients have a patent anastomosis, 7 and 10 months after removal of the stent. One patient died from metastases of bladder tumor. The three remaining patients are still stented. An urinoma occurred in one patient the day following removal of the stent, and was surgically drained. This new technique which combines electro-incision and stenting with a large caliber stent may be proposed as an alternative to surgery or balloon dilatation for the treatment of strictured uretero-digestive anastomoses.

Anastomosis, Surgical↗
PubMed1990

[Endoscopic treatment of common bile duct calculi].

The endoscopic treatment of calculi of the main biliary duct (CMBD) has been performed in France since 1974. One of us (Cl. L.) published his results with a series of 323 patients in 1979. The stones were extracted in 86.5% of all cases, the failures being caused by the impossibility to perform endoscopic sphincterotomy (ES) in 4.3% of cases or to extract the stones in 9.2%. Since that date, a number of factors helped improving the effectiveness of endoscopic treatment: the increasing experience of the surgeons, the improvement of endoscopes, especially more appropriate optics (wide angle and 15 degrees retrograde vision) and the endoscopic approach of the biliary tract, the use of intraoperative radiology allowing access to the biliary tract in all cases, and the development of extra- and intracorporeal lithotrity solving the problem of stones that cannot be extracted by conventional means. This work is aimed at demonstrating the current possibilities of the endoscopic treatment of lithiasis of the CMBD in a Hospital using plain radiology and lithotrity.

Ethers↗
PubMed1990

[Dissolution of gallbladder lithiasis with methyl tert-butyl ether (MTBE). Preliminary results in 9 cases].

Instillation of Methyl tert-butyl ether in the gallbladder permits the dissolution of cholesterol stones. Percutaneous transhepatic puncture of the gallbladder is the currently used approach; but shortcomings of this procedure could make the transpapillary cannulation of the cystic duct preferable. The reproducibility of this procedure, however, is not established. "In situ" dissolution is useful in cases of multiples stones which are not amenable to treatment with extra corporeal shock wave lithotripsy (ESWL). It can also be complementary to standard ESWL by promoting rapid disappearance of stones fragments. Preliminary results obtained in 9 patients suggest the necessity of rigorous selection criterias particularly regarding the chemical nature of the stones.

Adult↗
PubMed1989

[Interventional radiology in cancer of the exocrine pancreas and biliary tract].

Interventional radiology and operative endoscopy have considerably modified the diagnosis and treatment of neoplastic biliary obstruction. Ultrasound - or CT - guided needle biopsy provide a histological diagnosis without laparotomy. In almost every case, palliative treatment of jaundice can be performed by percutaneous stent insertion, due the combination of radiology and endoscopy. The major drawback of biliary drainage is the always possible distal obstruction of biliary stents.

Biliary Tract Neoplasms↗
PubMed1989

Indications for cholangioscopy.

Cholangioscopy permits new diagnostic and therapeutic procedures. It can be performed via the peroral route when anatomical conditions are suitable. This procedure was attempted in 6 cases (lithiasis in 5, malignant stenosis in 1): cholangioscopy proved possible in 4 cases, and lithotripsy was successful in 2 cases out of 3. Percutaneous transhepatic cholangioscopy was performed when peroral cholangioscopy was not possible (non-accessible papilla, hepatico-jejunostomy), or failed. In 17 patients with common bile duct (CBD) stones, unextractable by conventional procedures 14 underwent a cholangioscopy with electrohydraulic lithotripsy. Sixteen had complete clearance of the CBD. Cholangioscopy was attempted in 18 patients with intra-hepatic lithiasis. Lithotripsy was necessary in 10 cases and stenosis dilatation in 8. Results were excellent in 15 patients, and good in 3 with diffuse intra-hepatic lithiasis. In the case of lithiasis, the complication rate of the procedure was 29.5% and 27.7% for CBD and intrahepatic stones, respectively, and the mortality rate was 8.5% (n = 3). These complications (bleeding and cholangitis) are closely related to the percutaneous route. In malignant stenosis (n = 5), cholangioscopy was performed for diagnostic purposes in one case, extraction of a stent in one case and endobiliary laser treatment in 3 cases.

Adult↗
PubMed1988

[Dissolution of gallbladder lithiasis with methyl-tert-butyl-ether. Preliminary results: 9 cases].

Nine patients with gallstones were treated by injection of methyl-tert-butyl-ether (MTBE) into the gallbladder. Complete or incomplete dissolution was observed in 5 of the 9 patients. The 4 failures were due to 2 main factors: poor selection of the patients (2 of them had pigment gallstones) and inadequate mixture with the solvent floating above the bile and gallstones. In addition, 4 complications were noted, all of them being resolved by medical treatment. A better selection of the patients and a more efficient technique of MTBE injection should improve these results.

Adult↗