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Biomedical subjects

F Pigot

Publications and source records attributed to F Pigot.

At least 19 recordsLinked to original sources
PubMed2006

Low hemorrhoidopexy staple line does not improve results and increases risk for incontinence.

BACKGROUND: The ability of stapled hemorrhoidopexy (SH) to cure hemorrhoidal symptoms appears to depend on patient characteristics and operative technique. We assessed the association between outcome of SH and patients' characteristics and procedure parameters (associated procedure, suture line height, doughnut size, presence of malpighian tissue or smooth muscle in specimen). METHODS: A total of 68 consecutive patients (56 males) were prospectively operated by 3 different surgeons. Hemorrhoids were grade II (6%), grade III (76%) or grade IV (18%). RESULTS: At a mean 32-week follow-up (range, 9-77), symptoms had resolved in 77% of patients, independently of any operative or clinical parameter. New onset anal incontinence occurred in 11 men (17%): all had urgency, with flatus and liquid stool incontinence in two, and flatus incontinence and mucus soiling in one. Univariate analysis revealed that persistent incontinence was associated with a staple line <6.5 mm from the dentate line, doughnut height <22 mm, and congestive external hemorrhoids; it was also operator dependent (p<0.05). At the 4-week follow-up, 19% of patients had persisting symptoms but only 8% had a demonstrable mucosal prolapse. CONCLUSION: Although the success rate of SH may not be influenced by technical variations, risk for moderate incontinence is elevated when the stapled line is low.

Adult↗
PubMed2006

[Postoperative pain and long-term results after hemorrhoidal treatment with anopexy].

AIMS: Anopexy allows treatment of hemorrhoidal symptoms with a less painful postoperative course. This information is important for the patient, but may lead to dissatisfaction if pain level is higher than expected. To evaluate perceived pain and physical limitation levels in relation to patient's expectation. Evaluate long-term functional results. RESULTS: Sixty-eight consecutive patients (56 males) were prospectively included. Distribution of haemorrhoid grades were 4 grade 2 (6%), 52 grade 3 (76%) and 12 grade 4 (18%). Postoperative pain level was less or equal than expected for 85% of patients, with a better acceptance superior to 45 years. Physical limitation was equally or less important than expected for 89%. At the 32 weeks follow-up hemorrhoidal symptoms were present in 23%, uninfluenced by any patient's or operative characteristics. Incontinence with urgency was reported by 17%. Presence of an alliterated continence was linked to stapled line inferior to 6,5 mm from pectineate line, doughnut height inferior to 22 mm, external hemorrhoids and related to surgeon. CONCLUSION: Pragmatic information, although vague, about postoperative pain does not expose to patient's dissatisfaction. Functional results are not influenced by technical variation. Continence alterations are not severe, but frequent when stapled line is too close from pectineate line.

Adult↗
PubMed2003

Lack of effficacy of botulinum toxin in chronic anal fissure.

BACKGROUND AND AIM: Hypertonicity of internal anal sphincter plays a major role in the persistence of chronic anal fissure. Botulinum toxin could induce internal anal sphincter relaxation without the adverse effects of surgery (long-term faecal incontinence) or topical nitrates (anal burning, headaches, hypotension). METHODS: We conducted a placebo-controlled, randomised, double-blind study to assess the efficacy of a single injection of botulinum toxin in the internal anal sphincter of patients with chronic anal fissure in six ambulatory care clinics. Eligibility criteria included a mean value of post-defecation anal pain >or= 30 mm on a 100 mm visual analogue scale over the week preceding inclusion. Main endpoint was the proportion of patients with symptomatic improvement during the fourth week after inclusion (post-defecation anal pain below 10 mm). RESULTS: Forty-four patients (22 in each group) were included. At inclusion, there was no significant difference between groups on age, sex ratio, pain duration, post-defecation anal pain, analgesic consumption and stool frequency. Ten (45%) and 11 (50%) patients reported symptomatic improvement on the main endpoint (P=0.76) in placebo and botulinum toxin groups, respectively. Ten patients (five in each group) had healed fissure at week 4 and ten patients (five in each group) required surgical treatment between weeks 4 and 12. Similarly, there was no significant difference between groups on other variables between weeks 4 and 12. CONCLUSIONS: The efficacy of a single injection of botulinum toxin in the internal anal sphincter does not differ from that of a placebo in patients with chronic anal fissure.

Adolescent↗
PubMed2003

[Perineal necrotizing cellulitis disclosing rectal adenocarcinoma].

We report one case of rectal cancer disclosed by a perineal cellulitis in a diabetic woman. This infrequent association has a bad prognosis. Diagnosis is mainly clinical. Treatment is urgent with large spectrum antibiotic therapy, surgical debridement, colostomy and hyperbaric oxygen if available. Surgical treatment of the rectal cancer can be done immediately or delayed.

Adenocarcinoma↗
PubMed2001

[Hemorrhoids and hemorrhoidal disorders].

Haemorrhoids are normal anatomic components of the anal canal, involved in the fine adjustment of continence. This physiological role requires normal size and location. The anatomical aspects of haemorrhoids do not reflect their symptomatic expression. Natural evolution of haemorrhoids is benign, but most often chronic, with spontaneous worsening. Despite recent advances in medical and instrumental treatments, about 10% of the patients need a radical and definitive treatment relying on surgery. This comfort-oriented surgery should only be proposed to handicapped patients, after information about the rare (but possible) complications and the unavoidable transitory postoperative discomfort.

Constipation↗
PubMed2001

[Local excision with postoperative radiotherapy for T2 or T3 distal rectal cancer. Long-term results].

STUDY AIM: To evaluate, in a prospective study of a cohort of patients, the local recurrence rate of T2 or T3 rectal cancers treated by transanal excision after preoperative irradiation. PATIENTS AND METHODS: Between 1992 and 1999, 34 patients were treated after radiotherapy by a local excision for a distal rectal carcinoma limited to (stage T2) or invading through the muscular layer (stage T3). Four patients were excluded either for palliative treatment or lost for follow-up. Thirty patients were included in the study (8 uT2, 8 uT3, 14 undetermined preirradiation stage). RESULTS: After a 74-month mean follow-up (median: 46), the 5-year local recurrence rate was 33%. Even among subgroups of patients with a significant risk factor for local recurrence (size > 40 mm, clear margin < 2 mm, uT3 stage versus uT2) there were no benefits from irradiation. CONCLUSION: Local excision of T2 or T3 rectal cancers is associated with an elevated local recurrence rate. This result is demonstrated even after adjunction of a preoperative irradiation. So, local treatment must be restricted to clearly informed patients who definitively refuse a radical intervention.

Aged↗
PubMed2001

[Quality of life, symptoms of dyschezia, and anatomy after correction of rectal motility disorder].

AIM OF THE STUDY: To evaluate the quality of life of patients suffering from dyschezia and its correlation with symptomatic complaints and anatomical abnormalities, before and after elective surgery for rectal static disorder. PATIENTS AND METHODS: A prospective study was conducted using a general quality of life questionnaire (SF36) and a constipation specific score (PAC-QoL), a dyschezia symptom score, and defecography. RESULTS: Thirty-eight female dyschesic patients (mean age 54 years) underwent surgery for rectocele with (n=16) or without (n=14) internal rectal prolapse, an isolated internal rectal prolapse (n=3), or a total rectal prolapse (n=5). Preoperative quality of life was low, correlated with the intensity of dyschezia. Seven months after surgery, quality of life and dyschezia improved independently of the amplitude of the anatomical correction. More items improved in the constipation specific score than on the quality of life questionnaire; they were correlated with the course of dyschezia symptoms. Neither incontinence nor irritable bowel syndrome affected evolution of the symptoms. CONCLUSION: Surgery improved initially low quality of life and symptomatic complaints in patients with dyschezia and a rectal static disorder, independently of anatomic repair. Differences in changes observed in the PAC-QoL and SF36 suggest different fields of application.

Adolescent↗
PubMed1996

Transanal electroresection of small rectal cancer: a sole treatment?

PURPOSE: Because abdominoperineal resection is associated with high morbidity and mortality, there is interest in local treatment of distal rectal carcinoma. Our technique of transanal electroresection ensures full-thickness tumor excision and complete histopathologic examination. METHODS: From July 1983 to July 1990, 227 patients underwent surgery. Criteria for cure were no extramural invasion (61 exclusions) and negative margins (34 exclusions). Six patients underwent postoperative radiotherapy and, therefore, were excluded. RESULTS: Among those included were 126 patients (66 men), who had a mean age of 68 +/- 11 (median, 68) years. Median tumor size was 35 mm. Distance from anal verge was less than 6 cm for 68 percent and 6-10 cm for 30 percent of patients. Deepest layer invaded was as follows: submucosa (T1), 35 percent; inner muscular layer (T2a), 42 percent; outer muscular layer (T2b), 23 percent. There was one postoperative death. Immediate postoperative course was uneventful for 94 percent of patients; at long-term, five cases of incontinence and two stenoses were noted (6 patients). Median follow-up was 88 (1-137) months. Global survival was 71 and 46 percent, and cancer-specific survival was 85 and 81 percent at 5 and 10 years, respectively. Of 35 patients (28 percent) with recurrence, 24 were treated. Global survival after recurrence was 72 and 50 percent at one and two years, respectively. The only pejorative prognostic factors isolated for survival or recurrence were mucinous contingent and intratumoral vascular invasion. CONCLUSION: Results of local treatment for rectal carcinoma in selected patients are favorable (5-year specific survival, 85 percent). Decisive prognostic factors are seldom isolated, but some patients would benefit from adjuvant therapy.

Adult↗
PubMed1992

Human papillomavirus infection in esophageal squamous-cell carcinoma in western countries.

Recent studies have suggested that esophageal HPV infection could be a risk factor for esophageal squamous-cell carcinoma. The aims of our study were to assess the presence of HPV esophageal infection among French patients with esophageal squamous-cell carcinoma and to compare the prevalence of this infection among control patients exposed to similar known risk factors (alcohol and tobacco) and among non-exposed control patients. All patients had the following investigations: serum immunoglobulin level, T-lymphocyte subsets, cutaneous anergy test and endoscopy with biopsies from tumoral and normal areas. Three different methods were used for HPV-infection diagnosis: histological score, in situ hybridization intended for detection of HPV types 6, 11, 16, 18, 31 and 33, and dot blot intended for detection of HPV types 6/11 and 16/18. Five out of 12 patients with esophageal carcinoma had HPV esophageal infection. This infection did not result from impaired immune status. The most frequently observed types are HPV 16/18. None out of 17 exposed controls and only 1 out of 7 nonexposed controls had HPV esophageal infection (p less than 0.01). HPV infection may be implicated in the development of esophageal squamous-cell carcinoma in association with known risk factors.

Age Factors↗
PubMed1992

Low bone mineral density in patients with inflammatory bowel disease.

To assess the prevalence and risk factors for low bone mineral density in inflammatory bowel disease, we studied 61 consecutive patients, mean age 36 +/- 11 years. Twenty-seven had a Crohn's disease and 34 ulcerative colitis (including 13 with ileoanal anastomosis). Three patients, two women and one man (32, 70, and 45 years old, respectively) had vertebral crush fractures. Bone mineral density measured by dual energy x-ray absorptiometry at spine and femoral level was more than 2 SD below normal values in 23% of the patients, all of them having received steroid therapy. Eighteen patients (29%) had never received steroid therapy; their bone mineral density was not different than those who had. Univariate analysis showed a positive correlation between bone mineral density and body weight or oral calcium intakes, and a negative correlation with steroid daily dose. After ileoanal anastomosis, bone mineral density was not different from other groups and showed a positive correlation with time elapsed since coloproctectomy. We concluded that bone mineral density is low in patients with inflammatory bowel disease and exposes them to the risk of bone fracture. Bone mineral density after ileoanal anastomosis may increase with time after surgery.

Absorptiometry, Photon↗
PubMed1991

Kaposi's sarcoma of the colon in a young HIV-negative woman with Crohn's disease.

We report a case of isolated colonic Kaposi's sarcoma in a 36-year-old HIV-negative woman with refractory Crohn's disease of the colon and perineum following 11 months' treatment with azathioprine. The clinical features of this case are quite different from those classically described in Kaposi's sarcoma. Among the known risk factors, iatrogenic immunosuppression would appear to be the most probable.

Adult↗