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Biomedical subjects

D Mutter

Publications and source records attributed to D Mutter.

At least 73 records · Page 4Linked to original sources
PubMed1994

Implication of cholecystokinin in pancreatic adaptation after biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), a bariatric surgical procedure, leads to a malnutrition-induced general visceral atrophy except for the pancreas. This work investigates the implication of cholecystokinin (CCK) in the exocrine pancreatic adaptive process using a plasma CCK assay and the CCK receptor antagonist CR 1409. No significant reduction in weight and DNA content of the pancreas was noted 36 days after BPB, while a strong decrease in protein, enzymes and RNA contents indicating cellular hypotrophy became apparent. CR 1409 treatment strongly depressed pancreatic weight and its DNA content in BPB animals, suggesting an additional hypoplasia; however, the reduction in pancreatic enzyme content was not aggravated. BPB increased plasma CCK concentrations by 160%, unrelated to CR 1409 treatment. These results indicate that: (1) CCK is involved in the pancreatic adaptive response after BPB in rats, and (2) in the context of a protein malnutrition state, CCK dissociates its pancreatic growth and enzymatic effects, favouring the former.

Adaptation, Physiological↗
PubMed1994

[Implantable insulin pump: the first step towards an artificial pancreas].

Recent improvements in miniaturization of implantable pumps and the ability of their control by teletransmission allow implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient has died to date. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them leading to final pump explantation. Mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin assays were all lower versus pre-implantation assays. A statistically significant difference was demonstrated regarding mean global blood-sugar. The frequency of severe hypoglycemia incidents (2 in our series) and biochemical hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing a major benefit of the technique. The patients well-being and quality of life were notably improved. Implantable insulin-pump may be offered as alternative treatment to conventional insulin-therapy, especially in cases of diabetes which are difficult to control and particularly in cases with frequent hypoglycemic malaise.

Adult↗
PubMed1994

[Primary leiomyosarcoma of the femoral vein. Therapeutic aspects].

Leiomyosarcomas are exceptional in peripheral veins. Clinical signs are not specific, secondary to effects of the tumoural mass. Computed tomography and MRI give a precise topographic diagnosis. Pathology examination on biopsy or surgical specimens establishes the histological diagnosis. Therapeutic management must take into account local tumour recurrence and metastasis. Surgical exeresis should be wider than the tumour's pseudocapsule to include micrometastases neighbouring the primary tumour. Post-operative radiotherapy (55 to 70 Gy) and chemotherapy should follow. With this management scheme, local disease is controlled in 85% of the cases with a 5-year follow-up. Local or metastatic extension usually occurs within the first 3 years. Management of venous sarcomas thus requires a multidisciplinary cooperation between the surgeon, the radiotherapists and the chemotherapist.

Adult↗
PubMed1994

[In situ fibrinolysis of acute arteriovenous shunt obstructions during hemodialysis].

Several techniques (surgical revision, thrombectomy, ...) have been described for the treatment of thrombosed vascular access (VA) in hemodialysis patients. We propose a technique with local thrombolytic infusion in conjunction with angiography and percutaneous dilatation and/or recanalization. A total of fourteen patients with twenty-two episodes of thrombosed VA was studied. Eleven patients had a Brescia-Cimino fistula and three patients had a graft fistula. We used in 21 cases urokinase (243000 UI +/- 100000 UI) and in 1 case rt-PA (50 mg). Of the 22 VA, 19 issued in an immediate patency and were restored to full function; and whereof 17 remained patent more than 2 weeks. Failures occurred in 3 cases: localized bleeding from previous dialysis puncture sites (1), venous outflow obstruction (1), and resistant venous stenosis (1). There were no infectious complications, and no systemic bleeding complications. We observed one pseudoaneurysm and one humeral asymptomatic thrombo-embolism. Stenoses were the most frequent factor in precipitating thrombosis. We believe that our technique should be the first line of treatment of occluded hemodialysis vascular access.

Adult↗
PubMed1994

[Treatment of perforated duodenal ulcer: the celioscopic approach].

Ten patients underwent laparoscopic surgery for typical perforated peptic ulcer symptomatology. Two conversions to open surgery were due to technical problems related to delayed hospital admission. Nine patients underwent duodenal suture reinforced with fibrin glue, and one perforation was only glued. The postoperative course was uneventful without abdominal septic or abdominal wall complications in the eight patients treated by laparoscopy. Laparoscopic surgery may become the method of choice for the treatment of perforated peptic ulcer.

Adult↗
PubMed1993

[Laparoscopic surgery: a new alternative to abdominal surgery in renal insufficiency treated by CAPD].

Six laparoscopic abdominal operations were performed in five patients with chronic renal failure with continuous ambulatory peritoneal dialysis. Coelioscopic exploration and operation disclosed several advantages including peritoneal dialysis catheter salvage, abdominal exploration in peritonitis or before catheter implantation, early dialysis after surgery, hence avoiding the need for transient hemodialysis. Furthermore, laparoscopy was reported to decrease postoperative pain and ventilatory disorders. This minimal invasive surgical technique allows rapid recovery of social and professional activities.

Abdomen↗
PubMed1993

[Cutis verticis gyrata: reduction surgical treatment].

Cutis verticis gyrata (CVG) is a rare cause of acquired scalp thickening; in its primary form, the disease does not show any bone involvement. A 19-year old man had noticed a moderate thickening of the scalp at the age of 15. He progressively developed ridges and furrows in the occipital and parietal areas: after a four-year period, there were ten sagittal and irregularly parallel folds. There was neither pain nor pruritus, and the hair had a normal appearance. Complete neurological examination was unremarkable and the patient was of normal intelligence. All biological investigations, including STH and TSH levels, were normal. X-ray examination and tomodensitometry did not show any bone involvement. Our patient was treated by surgical reduction of the scalp areas involved under general anesthesia, with a very good result. This is a typical case of primary CVG. Differential diagnosis of primary cutis verticis gyrata comprises pachydermoperiostosis, cerebriform intradermal nevus and many secondary conditions associated with hypertrophy and folding of the scalp. A relatively simple surgical treatment results in a major reduction of the scalp thickening, and avoids maceration.

Adult↗
PubMed1993

[Severe complications after cholecystectomy by celioscopy: lessons from yesterday and today].

The case of a series of grave complications after a laparoscopic cholecystectomy is reported: a common bile duct section diagnosed rather late, hemoperitoneum, inappropriate common bile duct reconstruction and late anastomic leakage, stenosis of an hepatico-jejunal anastomosis, haemorrhage through the external biliary drainage and iterating sepsis. The final outcome was good. The stenotic hepatico-jejunal anastomosis was dilated by a Gianturco self-expanding prosthesis percutaneously placed. As an evidence, this alternative treatment is only exceptional, the treatment of choice for postsurgical benign strictures being surgical repair.

Anastomosis, Surgical↗
PubMed1993

[Boerhaave syndrome or spontaneous rupture of the esophagus].

Spontaneous rupture of esophagus is a rare affection resulting from barotrauma to lower esophagus during the effort of vomiting. The diagnosis is suggested by the presence of violent retrosternal pain after a bout of vomiting following the partaking of a copious meal by an alcoholic patient. Prognosis is dependent on the rapidity of treatment, always surgical and completed by long-term antibiotic therapy. Complementary examinations should be limited to a standard chest x ray and esophageal imaging with water-soluble contrast. Recovery is now the rule for patients treated within 24 hours. Mortality is high in patients diagnosed at a late stage, but this could be reduced by improved recognition of the syndrome.

Adult↗
PubMed1992

In vitro resistance of artificial connective tissues to human bile and pancreatic juice.

The resistance of connective tissue generated from elastin, placenta extracts and human collagen was tested by in vitro incubation with bile and pancreatic juice to investigate the potential use in human digestive surgery. The resistance, determined by macroscopical and microscopical examinations, has been directly compared to those of bovine collagen matrices (Spongel, Pangen, Helistat, Translagen). Only the compact and cross-linked human collagen patch resisted both bile and pancreatic juice. All other biomaterials tested dissolved either in bile or in pancreatic juice. The in vivo behaviour of this new human collagen matrix and its involvement in gastrointestinal wound healing must now be investigated.

Animals↗
PubMed1992

[Validation of the measurement of hepatic volume by three-dimensional computed tomography].

The aim of this work was to verify experimentally the reliability of 3D CT scan in measuring hepatic volumes. Eight livers were dissected from corpses. The referring liver volume was determined by measure of its hydric shift. The correlation coefficient R was 0.93 (p < 0.001) on 5 mm/5 mm 3D sections, 0.92 (p < 0.001) on 10 mm/10 mm 3D sections and 0.94 (p < 0.0006) on 5 mm/10 mm 3D sections. The paired t-test also showed a 5% risk correlation between the two measurements. Although in vivo imaging is slightly different from in vitro, 3D CT scan seems to be a reliable method to determine an hepatic volume without increased X-ray irradiation.

Humans↗
PubMed1992

[Is cholecystectomy by celiovideoscopy dangerous in the initial period? Prospective study of 100 initial cases].

The aim of this study was to prospectively study the complication rate of our 100 initial laparoscopic cholecystectomies. The ultimate goal was to obtain a morbidity rate comparable to open cholecystectomy. No major complications were noticed. The conversion rate to open cholecystectomy was 8%, slightly higher in comparison with the literature. Absence of major complications could be explained by: a) indications limited to symptomatic non complicated cholelithiasis; b) assistance at the beginning of our experience of gynecologists used to laparoscopic techniques; c) conversion to open cholecystectomy in case of technical difficulties. Application of these principles allows the digestive surgeon to start laparoscopic cholecystectomy without submitting the patient to additional risks.

Adolescent↗