To perform or not D2 extended lymphadenectomy in patients with gastric cancer in the West. Effectiveness and limits.
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Europe↗
Biomedical subjects
I Oliver
Publications and source records attributed to I Oliver.
Is anal endosonography useful in the study of recurrent complex fistula-in-ano?
INTRODUCTION: performing anal endosonography in complex fistula-in-ano allows us to design a personalized surgical strategy in each case, thereby improving results. However, there are doubts in the literature as to its utility in recurrent complex fistulas. The aim of this study was to compare the utility of anal ultrasonography in the study of primary versus recurrent complex fistula-in-ano. PATIENTS AND METHOD: prospective study of patients diagnosed and treated for complex fistula-in-ano. Physical examination and anal ultrasonography provided data on primary track, internal opening, horseshoe extension and the presence of secondary tracks or cavities in a protocol designed specifically for the study. These assessments were subsequently contrasted with operative findings. RESULTS: we included 35 patients, 19 (54.3%) with primary complex anal fistulas and 16 (45.7%) with recurrent fistulas. According to the operative findings, fistulas were classified as high transsphincteric in 28 patients (80%), suprasphincteric in 6 (17.1%) and extrasphincteric in one patient (2.9%), with no differences between groups. Physical examination correctly classified 28 of the 35 fistulous tracks, in contrast to the 32 (91.4%) correctly described on ultrasonography (80%). We did not find any statistically significant differences between the primary and the recurrent fistula groups with regard to sensibility, positive predictive value and accuracy of the anal ultrasonography for any of the parameters studied. CONCLUSION: the accuracy of anal ultrasonography does not decrease in recurrent complex fistula-in-ano.
Anal Canal↗
A case of trisomy 12 mosaicism with pituitary malformation and polycystic ovary syndrome.
We report the case of a patient (followed from birth to 15 years) presenting with trisomy 12 mosaicism, and focus on the endocrine phenotype associating a pituitary malformation and ovarian abnormalities. We describe the dysmorphic features and their evolution, the growth retardation and ovarian symptoms. Complete growth hormone deficiency was confirmed on auxological data, stimulation test and was related to pituitary stalk interruption, diagnosed by magnetic resonance imaging. Effect of growth hormone treatment was satisfactory resulting in a normal adult height. She also presented premature thelarche associated with right ovarian hypertrophy (4 to 5 fold the volume of the left ovary) which remained constant until 15 years of age. Diagnosis of trisomy 12 mosaicism was made on skin and ovarian karyotypes. The possible relation between these endocine findings and some genes located on chromosome 12 involved in pituitary and ovarian development is discussed.
Abnormalities, Multiple↗
Invasive group A streptococcal disease: should close contacts routinely receive antibiotic prophylaxis?
Group A streptococci (Streptococcus pyogenes) causes a wide range of illnesses from non-invasive disease--eg, pharyngitis--to more severe invasive infections--eg, necrotising fasciitis and toxic shock-like syndrome. There remains uncertainty about the risk of secondary cases of invasive disease occurring among close contacts of an index case and how best to manage that risk. We do not consider that currently available evidence justifies the routine administration of chemoprophylaxis to close contacts. We suggest that the appropriate response should be to routinely inform all household contacts of a patient with invasive group A streptococcal disease about the clinical manifestations of invasive disease and to seek immediate medical attention if they develop such symptoms.
Anti-Bacterial Agents↗
Multidrug resistance-associated protein (MRP1) gene is strongly expressed in gastric carcinomas. Analysis by immunohistochemistry and real-time quantitative RT-PCR.
AIMS: To assess MRP1 protein and MRP1 mRNA levels in gastric carcinomas and in non-neoplastic mucosa remote from the tumours. MRP1 gene expression may play a role in the complex pattern of chemoresistance present in gastric carcinomas. METHODS AND RESULTS: A total of 57 carcinomas and respective gastric tissues were included for immunohistochemical assessment with the anti-MRP1 monoclonal antibodies MRPr1 and QCRL-1. Of these, 35 tumour and gastric mucosa tissues were also assessed by real-time quantitative reverse transcriptase-polymerase chain reaction. Medium or high MRP1 protein expression was detected in 89% and 77% of carcinomas and in 96% and 93% of non-neoplastic gastric mucosa by MRPr1and QCRL-1, respectively. No difference in MRP1 mRNA levels was detected between carcinomas and non-neoplastic gastric mucosa tissues in 77% of the patients. A significant correlation was found between MRP1 mRNA level and protein expression detected in carcinomas related to non-neoplastic gastric mucosa, although they were non-concordant in 29% of the patients. CONCLUSIONS: MRP1 gene is usually expressed in most gastric carcinomas and does not differ substantially from that observed in non-neoplastic gastric mucosa remote from the tumour. However, a decrease in MRP1 gene expression is found in some carcinomas. For accurate assessment of changes in MRP1 expression between tumour and normal tissues both protein and mRNA detection are necessary.
Gastric Mucosa↗
An upper abdominal swelling causing nausea and vomiting.
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Aged↗
Can some growth hormone (GH)-deficient children benefit from combined therapy with gonadotropin-releasing hormone analogs and GH? Results of a retrospective study.
Recombinant GH (rGH) treatment does not invariably correct height deficits in GH-deficient children once puberty has begun. The addition of GnRH analogs (GnRHa) to delay puberty has been advocated, but published results are few and sometimes conflicting. We retrospectively compared GH-deficient children treated with rGH and GnRHa for at least 1 yr after entering puberty and having attained their final height (n = 23) with a matched control group treated only with rGH. Overall, combined therapy did not significantly increase final height relative to rGH alone. However, the shortest girls at the onset of puberty (<25th percentile) benefited more than the tallest (>75th percentile) in both final height relative to predicted height and pubertal catch-up growth. In the control group, patients having experienced intrauterine growth retardation (IUGR) attained a lower mean final height than patients without IUGR (difference significant in boys, but not in girls). In the combined therapy group, IUGR did not affect the final height of either sex. Our results suggest that two populations might benefit most from combined GnRHa and rGH therapy: girls particularly short at the onset of puberty and patients who had experienced IUGR. Further prospective studies are required to confirm these preliminary hypothesis.
Adolescent↗
Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient?
Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large defects (> 3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years, with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia size, 143 patients (67.1%) presented with small defects (< 3 cm). The anaesthetic technique of choice was local plus sedation. Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%), the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary tissue repair.
Adolescent↗
Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment.
BACKGROUND AND AIMS: Anal abscess is a frequent acute proctological disorder and whether the underlying fistula should be treated at the same time when the abscess is drained remains controversial. We examined indications for drainage alone versus drainage plus fistulotomy in terms of recurrence and continence. PATIENTS AND METHODS: We carried out a randomized prospective study of 200 consecutive patients with anal abscess. One group received drainage alone, while in the other group drainage plus fistulotomy was performed when a subcutaneous-mucosa, low transsphincteral, or intersphincteral fistula was found. Delayed progressive fistulotomy with suture threads was performed in cases of high transsphincteric or suprasphincteric fistula. RESULTS: The internal opening of the fistula track was found in 83% of the patients. The recurrence rate was related to the surgical technique employed: 29% in the group with drainage alone and 5% in the group for which treatment of the fistula track was attempted. The incontinence rate was also related to the surgical option. In those receiving drainage and treatment of the fistula track incontinence was restricted mostly to patients with delayed fistulotomy (36.7%), compared to 2.8% of patients when simple fistulotomy was performed. There was no incontinence in the drainage alone group. CONCLUSION: Drainage of anal abscess with fistulotomy can be safely performed in cases of subcutaneous, intersphincteral, or low transsphincteral fistulae with a minimal recurrence rate. However, drainage alone and posterior treatment of the fistula track is recommended for high transsphincteral or suprasphincteral fistulae.
Abscess↗
[Analysis of a programme of direct referral between primary and specialist care in potential surgery patients].
OBJECTIVE: To describe the results of a programme of direct referral of potential surgery patients between primary and specialist care, designed to lessen waiting-times.Design. Prospective, longitudinal and descriptive study. SETTING: Health Area N. masculine 19 (Valencian Health Service): Surgery Service of Elche Hospital and 6 Health Centres. PARTICIPANTS: Patients with pathologies that do not need special techniques for diagnosis except examination and who have a clear irrefutable indication of surgery without risk factors (ASA I-II).Intervention. The referral protocol consists of: a) diagnosis of pathology and pre-operative study in primary care (PC); b) appointment made by phone for the surgery clinic at the hospital, where diagnosis and pre-operative study are confirmed; c) referral and operation in the unit of non-hospital major surgery (UCMA); d) monitoring post-operation by the home hospitalisation unit (HHU) or preferably by the health centre, and e) check-up at the surgery clinic. Main measurements. The degree of agreement between PC and the specialist, assessment of the pre-operative study, and waiting time. RESULTS: 86 patients were referred (average age, 35; 76% male) by 28 doctors. The most common pathologies were hernia (36%), pilonidal sinus (23.2%) and miscellaneous (32.5%). There was general agreement in diagnosis in 90.7% of cases. 89.5% of patients brought the proper pre-operative study. Mean waiting time between the primary care consultation in the different procedures and the first hospital consultation was 19 days; with 44 more days elapsing till the surgical operation. CONCLUSIONS: This new programme is effective and economic, in that there is < > of patients, waiting time is reduced by over 7 months for pilonidal sinus and by over 2 years for hernia pathology, and the procedure can be used for a large number of patients, as the pathologies involved are very common.
Adolescent↗
Chunking mechanisms in human learning.
Pioneering work in the 1940s and 1950s suggested that the concept of 'chunking' might be important in many processes of perception, learning and cognition in humans and animals. We summarize here the major sources of evidence for chunking mechanisms, and consider how such mechanisms have been implemented in computational models of the learning process. We distinguish two forms of chunking: the first deliberate, under strategic control, and goal-oriented; the second automatic, continuous, and linked to perceptual processes. Recent work with discrimination-network computational models of long- and short-term memory (EPAM/CHREST) has produced a diverse range of applications of perceptual chunking. We focus on recent successes in verbal learning, expert memory, language acquisition and learning multiple representations, to illustrate the implementation and use of chunking mechanisms within contemporary models of human learning.
Journal Article↗
[Modelization of growth between 0 and 3 years of age in children born in Toulouse in 1993-1994 and comparison with Sempé's growth curves].
AIM: The growth charts usually used in France were established by Sempé et al from the study of children born in 1953-1955. The aim of our study was to construct longitudinal growth charts from 0 to 3-year-old children born in 1993-1994, and to compare those with the charts made 40 years ago. POPULATION AND METHODS: One hundred forty-five term neonates (75 boys and 70 girls) born in Toulouse in 1993-1994 were included in our study. Their heights were noted every 3 months during the first year of life, then every 6 months until the age of 3. A two-stage model to modelize growth curves was used for the available data (66 boys and 61 girls). RESULTS: Mean heights were higher in our study than in Sempé's. In each sex, the mean curve was 0.6 to 0.8 SD far from Sempé's mean curve. Standard deviations rose from 2.0 to 4.0 cm between the ages of 2 months and 3 years. At the age of 3, boys and girls were respectively 2.7 cm and 2.3 cm taller than in the Sempé's study. Differences could not be explained by sample bias. DISCUSSION: Constructions and publication of recent French growth charts seem necessary in order to be able to compare one child's growth to the growth of same age and sex children.
Age Factors↗
[Pituitary stalk transection syndrome].
BACKGROUND: Pituitary stalk transection is a non-negligible cause of growth hormone (GH) deficiency. POPULATION AND METHODS: We studied 22 children (13 boys, nine girls) aged at the first clinical manifestations from 2 days to 10 years (average = 5.33 +/- 2 years). Pituitary stalk transection was assessed by the means of magnetic resonance imaging (MRI). The children's past history showed fetal distress in 12 cases (54.5%), cranial trauma in three (13%) and a midline anomaly in three (13%). The first clinical manifestations were neonatal hypoglycemia (two cases), decreased growth velocity (18 cases) and diabetes insipidus (two cases). RESULTS: GH deficiency was complete, present from the onset in 19 of 22 cases and isolated in four. Fifteen of 22 cases had adreno-corticotrophic hormone (ACTH) and thyroid stimulating hormone (TSH) deficiency. Diabetes insipidus was present in six cases and revealed the syndrome in two. All children older than normal age of puberty (n = 10) had gonadotropin deficiency. In our study, these hormonal anomalies progressed from isolated GH deficiency to multiple hormonal deficiencies. CONCLUSION: The recently described stalk transection syndrome is relatively frequent and should be suspected after cranial trauma or fetal distress syndrome. The outcome is progressive evolution towards panhypopituitarism and these patients require regular clinical survey and hormonal controls.
Adrenocorticotropic Hormone↗
Failure to detect early recurrence of gastric cancer.
Early gastric cancer recurrence is sometimes difficult to diagnose even by protocols using imaging techniques and tumor markers. We report a gastric cancer recurrence diagnosed by the appearance of a Sister Mary Joseph's nodule that illustrates the lack of sensitivity of these methods. We also discuss the protocol we currently follow for these patients.
Anastomosis, Roux-en-Y↗
The role of calmodulin in the gravitropic response of the Arabidopsis thaliana agr-3 mutant.
Calmodulin, a primary plant calcium receptor, is known to be intimately involved with gravitropic sensing and transduction. Using the calmodulin-binding inhibitors trifluoperazine, W7 and calmidazolium, gravitropic curvature of Arabidopsis thaliana (L.) Heynh, ecotype Landsberg, roots was separable into two phases. Phase I was detected at very low concentrations (0.01 microM) of trifluoperazine and calmidazolium, did not involve growth changes, accounted for about half the total curvature of the root and may represent the specific contribution of the cap to gravity sensing. Phase II commenced around 1.0 microM and involved inhibition of both growth and curvature. The agr-3 mutant exhibited a reduced gravitropic response and was found to lack phase I curvature, suggesting that the mutation alters either use or expression of calmodulin. The sequences of wild-type and agr-3 calmodulin (CaM-1) cDNAs, which are root specific were completely determined and found to be identical. Upon gravitropic stimulation, wild-type Arabidopsis seedlings increased calmodulin mRNA levels by threefold in 0.5 h. On the other hand, gravitropic stimulation of agr-3 decreased calmodulin mRNA accumulation. The possible basis of the two phases of curvature is discussed and it is concluded that agr-3 has a lesion located in a general gravity transmission sequence, present in many root cells, which involves calmodulin mRNA accumulation.
Arabidopsis↗
Final results of a randomised trial comparing 'Tomudex' (raltitrexed) with 5-fluorouracil plus leucovorin in advanced colorectal cancer. "Tomudex" Colorectal Cancer Study Group.
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Adenocarcinoma↗
[Precocious puberty and polycystic ovarian syndrome: apropos of 13 cases].
BACKGROUND: Precocious puberty and polycystic ovarian syndrome are two different entities which appear at different stages of ovarian development. Their association is uncommon. POPULATION: Thirteen girls presented idiopathic central precocious puberty with sexual development before the age of 8 years; menstruations were seen at the age of 9.5 years in one patient. Nine of them were given medroxyprogesterone or cyproterone acetate and two patients LHRH analog. Menarche occurred at a mean age of 11.8 +/- 1.5 years. After a mean free interval of 22 months, these thirteen patients developed hirsutism with irregular menstruations (eight patients) and weight gain (seven patients). The diagnosis of polycystic ovarian syndrome was confirmed by increased plasma testosterone (mean 91.1 +/- 14 ng/dl) and LH levels during LHRH test and by ultrasonography or coelioscopy. The treatment included cyproterone acetate plus 17 beta oestradiol; it was discontinued in eleven cases after 2 years of treatment. Plasma testosterone levels were normal 6 months later in association with regular menstruations. But three patients presented clinical and hormonal recurrence one year later, requiring repeated treatment. CONCLUSION: This association seems to be related to the same gonadotropin dysfunction. It is necessary to regularly follow patients treated for precocious puberty.
Androgen Antagonists↗