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Biomedical subjects

J Boulez

Publications and source records attributed to J Boulez.

At least 19 recordsLinked to original sources
PubMed2007

Characterization of reflux events after fundoplication using combined impedance-pH recording.

BACKGROUND: Laparoscopic fundoplication effectively controls symptoms of gastro-oesophageal reflux disease (GORD) and decreases acid reflux, but its impact on non-acid reflux is not known. The aim of the study was to characterize reflux events after fundoplication using oesophageal combined multichannel intraluminal impedance (MII)-pH monitoring, to demonstrate its efficacy on acid as well as non-acid reflux events. METHODS: Thirty-six patients in whom ambulatory MII-pH recording was performed after laparoscopic fundoplication were reviewed retrospectively. There were 23 symptomatic and 13 asymptomatic patients, whose results were compared with those of 72 healthy volunteers. RESULTS: Oesophageal acid exposure was low in all but one operated patient, and there was no difference between those with and without symptoms. The median number of reflux events over 24 h was lower after fundoplication (11 in operated patients compared with 44 in healthy volunteers; P < 0.001). Almost all reflux events were non-acid after surgery whereas acid reflux episodes were predominant in healthy volunteers. Proximal reflux events were less common in operated patients. Non-acid reflux events were significantly associated with symptoms after surgery in some patients. CONCLUSION: Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms.

Adult↗
PubMed2003

[Laparoscopic pancreatic resections].

The feasibility of laparoscopic pancreatic resection has been demonstrated. However, the real clinical benefit for the patients remains questioned. The best indication for a laparoscopic approach appears to be the resection of benign or neuro-endocrine tumors without a need for pancreato-enteric reconstruction (i.e enucleation or distal pancreatectomy). The use of the laparoscopic approach for malignant tumors still remains controversial. The benefits of minimally invasive surgery are clearly correlated with the successful management of the pancreatic stump. Pancreatic related complication rate (fistula and collection) is 15% when using pancreatic transection with a laparoscopic endostappler.

Humans↗
PubMed2001

Complete response of an HIV negative gastric Kaposi's sarcoma (KS) patient with peritoneal carcinomatosis by liposomal daunorubicin treatment.

We report the first case of an HIV negative patient with gastric Kaposi's sarcoma (KS) and peritoneal carcinomatosis in whom a complete response (CR) was obtained after liposomal daunorubicin administration. The patient presented with epigastric pain and hematemesis. Upper gastric endoscopy with multiple biopsies showed gastric involvement by KS. The whole physical examination and the thoraco-abdomino-pelvic CT scans showed no other localization. A total gastrectomy was performed. Histological examination confirmed the diagnosis of KS with involvement of regional lymph nodes and peritoneal lesions. Six cycles of liposomal daunorubicin were given. Post-treatment coelioscopic control was normal. The patient received another six adjuvant cycles of liposomal daunorubicin. The patient is in complete remission six months after the end of treatment. Liposomal daunorubicin is a promising treatment in the non HIV patient with visceral KS.

Adult↗
PubMed2001

Cystic endocrine tumors of the pancreas: clinical, radiologic, and histopathologic features in 13 cases.

Cystic endocrine tumors of the pancreas are rare and raise difficult clinical problems. Our aims were to reevaluate the diagnostic and therapeutic strategy and to assess their histopathologic characteristics. Thirteen cystic endocrine tumors diagnosed in 10 patients were included. Clinical, radiologic, and pathologic data were reviewed. There were 6 male and 4 female patients (median age, 46 yrs). Six patients had evidence of multiple endocrine neoplasia type 1 (MEN1) disease. Four had a functional endocrine syndrome. Ten tumors were visible on imaging studies. The most suggestive radiologic features were the existence of a peripheral hypervascular rim (10 cases) and images of cyst into cyst (two cases). On gross and histologic examinations, two distinct types were present. Macrocystic tumors (six cases) were unilocular and limited by a thick wall containing nests of tumor cells. Microcystic tumors (seven cases) were characterized by the presence of multiple cystic spaces directly lined by tumor cells. Surgical resection was performed in all cases. Three patients had lymph node metastases at the time of diagnosis. One patient is dead with metastatic dissemination. The others are alive without recurrence or metastasis. The diagnosis of endocrine tumor must be considered for any pancreatic cyst discovered in a patient with a history of MEN1 syndrome or with clinical features suggestive of this syndrome. Cystic pancreatic endocrine tumors must be treated by surgical resection because of their possible malignant evolution.

Adult↗
PubMed2001

[Hepatobiliary cystic tumors. Clinical, radiological and histopathological study of 7 cases].

OBJECTIVES: Hepatobiliary cystic tumors are rare, but must be correctly diagnosed because of their potential malignancy. We report the clinical, radiological, pathological and evolutive characteristics of 7 cases of hepatobiliary cystic tumors. MATERIAL AND METHODS: Complete clinical charts were available. Radiological and pathological documents were reviewed. RESULTS: There were 4 females and 3 males (median age, 58.7 yrs). In 3 cases, the presenting symptom was the palpation of a mass in the right upper abdominal quadrant. In 6 cases, pre-operative imaging studies showed a cystic intra-hepatic mass, containing vegetations and/or septa in 5 cases. In the remaining case, the radiological appearance showed a heterogeneous liver mass. Two patients were treated by pericystectomy and 5 by radical hepatectomy. At macroscopic examination, tumors were usually large (range: 2-24 cm) and multilocular. Histological diagnosis was: cystadenoma with mesenchymous stroma (2 cases), mucinous cystadenoma (2 cases), mucinous cystadenocarcinoma (2 cases), giant cell cystadenocarcinoma (1 case). The mean duration of follow up was 60 months. Two patients, both with cystadenocarcinomas, died after respectively, 21 and 34 months with metastatic dissemination. Five patients are alive without evidence of disease after a delay ranging from 14 to 144 months. CONCLUSION: Radical surgical treatment of cystic hepatobiliary tumors is necessary to obtain histopathological examination of the complete specimen, which is essential for a correct evaluation of the malignant potential of the lesion, and for prolonged survival, even in cases of locally invasive tumors.

Adult↗
PubMed2000

[Pneumatosis cystoides intestinalis, treated with laparoscopic colectomy].

The authors report a case of pneumatosis cystoides intestinalis which, after failure of medical treatment, was treated by laparoscopic partial colectomy. Surgical treatment is a last resort and the laparoscopically-assisted approach seems to be a good indication in colectomy for pneumatosis cystoides intestinalis.

Abdominal Pain↗
PubMed2000

Laparoscopic fundoplication for gastroesophageal reflux: effects on esophageal motility.

Laparoscopic Nissen-Rossetti fundoplication is now recognized as a valid therapy for the treatment of gastroesophageal reflux disease. This retrospective study evaluates the effects of laparoscopic fundoplication on esophageal motility and correlates these effects to postsurgical symptoms. A total of 123 patients underwent laparoscopic fundoplication at our institution. Pre- and postoperative esophageal manometric data were analyzed with regard to the effect of surgery and postsurgical outcome. Postoperative lower esophageal sphincter pressure was significantly increased compared wtih preoperative values (1.7 +/- 0.8 kPa vs 0.9 +/- 0.7 kPa). Duration and amplitude of esophageal body contractions were not modified. The percentage of deglutition-induced complete peristaltic waves and the velocity of propagation were significantly decreased after surgery (P < 0.05). Postoperative symptoms were significantly correlated with postoperative lower esophageal sphincter pressure only. Laparoscopic fundoplication significantly increases lower esophageal sphincter pressure. It significantly decreases esophageal body peristaltic efficiency, a decrease that is most likely of minor clinical significance.

Adolescent↗
PubMed1999

[Colonic diverticulosis and laparoscopy. Analysis of a series of 60 cases].

AIM: This is a retrospective analysis of a series of 60 cases diverticular disease. MATERIAL AND METHOD: From May 1991 to April 1999, 60 laparoscopic colorectal resections were performed for diverticulitis. RESULTS: Conversion to a classical procedure was necessary in 3 patients (5%). There was no mortality and 9 postoperative complications (3 reoperations). The mean length of hospital stay was 9 days, and 6.3 days for patients in whom surgery was performed after January 1998. CONCLUSION: Laparoscopic surgery for diverticular disease is associated with acceptable morbidity and mortality rates and a short median postoperative stay.

Adult↗
PubMed1997

[Heller's esocardiomyotomy without anti-reflux procedure by the laparoscopic approach. Analysis of a series of 27 cases].

From November 1992 to June 1996, 27 laparoscopic Heller's myotomies without antireflux procedure were performed. One mucosal tear occurred and was treated by open surgery. There was no mortality; one case of sepsis with a good outcome was observed on the converted patient. The mean length of hospital stay was 5.5 days. The immediate functional result was good in all cases. Postoperative esophageal manometry showed a significant reduction of the LES pressure, and post-operative pHmonitoring showed one case of reflux. The long term functional result was good in 81% of cases, moderate in 19% (slight reflux in 3 cases and dysphagia in 2 cases). No failure and no reoperation occurred in this series. This procedure has been applied to all patients with achalasia since December 1992.

Adult↗
PubMed1995

Laparoscopic Nissen-Rossetti fundoplication. First results.

From January 1992 to July 1994, 148 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent Nissen-Rossetti fundoplication by a laparoscopic approach. There was no conversion and no postoperative death. The main intraoperative complications were hemorrhage (n = 12), pleural opening (n = 5), and gastric perforation (seromuscular effraction) (n = 1). Laparoscopic reoperation was necessary in two patients as a result of bleeding, and there were two cases of food impaction. The median hospital stay was 4.9 days; 117 patients were observed for follow-up for 3-31 months (median 6.2 months). Eleven cases of dysphagia extending beyond 2 months have been observed. In five of those cases, endoscopic dilatation provided effective treatment of dysphagia and in four others, a further laparoscopic intervention enabled a cure to be obtained. Eighty-four percent are satisfied with their decision to have the operation. The laparoscopic Nissen-Rossetti fundoplication can be carried out safely and effectively with positive results similar to those obtained with the open procedure and with all of the advantages of the minimally invasive approach.

Adolescent↗
PubMed1995

[Results of the celioscopic treatment of gastroesophageal reflux according to Nissen-Rossetti. Apropos of 94 cases].

From January 1992 to July 1993, 94 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent laparoscopic Nissen-Rossetti fundoplication. The median follow-up was 4.5 months. There was no conversion to open surgery and no postoperative mortality. Laparoscopic reoperation was necessary in 2 patients haemorrhage and there were 2 cases of food impaction. 6 patients developed a chest postoperative infection. 6 cases of dysphagia extending beyond 2 months were observed. In 3 of these cases, endoscopic dilatation provided effective treatment of dysphagia, and in 3 others, a further laparoscopic operation achieved cure. We observed 2 relapses of hiatal hernia, one of which was a voluminous recurrent paraesophageal hernia, and the other was a patient with slipped-Nissen. 84% of patients were satisfied with the surgical result. Laparoscopic fundoplication is an effective the treatment for gastroesophageal reflux.

Adult↗
PubMed1993

Results of splenectomy for idiopathic thrombocytopenic purpura. Review of 72 cases.

Seventy-two patients underwent splenectomy for idiopathic thrombocytopenic purpura between 1979 and 1990. Mean age at splenectomy was 36.4 years (range 11-73). Indications for splenectomy were corticodependence in 21 cases and resistance to steroids in 44 cases. Thirty-five patients had platelet kinetic studies by 51Cr alloplatelets; 22 of them had splenic sequestration. Hematologic results were evaluated on discharge, at 3 months and in the long term (median follow-up 5.4 years). We had no mortality, morbidity was seen in 7% of the cases. None of the patients suffered from secondary infectious complications. 89% had good results on discharge (> 120 x 10(9)/l), 72.6% at 3 months and 90% on long-term follow-up. Factors associated with good response to splenectomy included a high postoperative platelet count (more than 120 x 10(9)/l on discharge), younger age at the time of surgery, preoperative corticodependence and predominantly splenic sequestration.

Adolescent↗
PubMed1993

[Primary hyperparathyroidism in 2 adolescents].

The authors report on two cases of primary hyperparathyroidism (PHP) in adolescents. In a 15-year-old boy, the clinical picture included skeletal, dental, renal and psychological manifestations. In the second case, the first symptom was urolithiasis at age 12; following a period without any important clinical event, the diagnosis was established when the patient was 18. In both cases, increased calcium and low phosphorus plasma levels associated to moderately elevated plasma parathyroid hormone levels were noted. CT scan and ultrasounds were normal but MRI showed an enlarged gland in the second case. The surgical exploration of the neck revealed an adenoma in the first case and a hyperplastic gland in the second one. Surgery was followed by an immediate improvement of both clinical and laboratory findings. These observations bring us to examine the spectrum of PHP in childhood, the difficulties in biological diagnosis and localizing techniques, and the recent results of surgical treatment.

Adolescent↗
PubMed1991

Microalbuminuria is acutely increased during anesthesia and surgery.

Microalbuminuria is known to increase in various diseases with potential repercussion on the kidneys and indicates an increase in glomerular intracapillary pressure or changes in permeability characteristics. In this study, we measured whether albumin excretion is affected in patients undergoing anesthesia and surgery, which are both known to induce dramatic changes in renal function and in the release of vasoactive substances such as catecholamines, vasopressin, angiotensin, and prostaglandins. Seven patients with normal renal function and physiological microalbuminuria prior to surgery were studied. Urine samples were collected before anesthesia, just before the beginning of surgery, and thereafter 30 min following incision, and 30 min after the end of surgery. Anesthesia induced a significant increase in microalbuminuria, which further increased during surgery. After the end of surgical procedure, microalbuminuria decreased but remained significantly higher than control. This phenomenon may be due to an increase in intracapillary glomerular pressure and/or an alteration in glomerular permeability induced by a direct effect of drugs, or to the action of vasoactive substances on the glomerular structure.

Adult↗