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J C Le Neel

Publications and source records attributed to J C Le Neel.

At least 19 recordsLinked to original sources
PubMed2003

Neurochemical coding of myenteric neurones in the human gastric fundus.

The major functions of the stomach are under the control of the enteric nervous system (ENS), but the neuronal circuits involved in this control are largely unknown in humans. Enteric neurones can be characterized by their neuromediator or marker content, i.e. by neurochemical coding. The purpose of this study was to characterize the presence and co-localization of neurotransmitters in myenteric neurones of the human gastric fundus. Choline acetyltransferase (ChAT), neurone-specific enolase (NSE), vasoactive intestinal polypeptide (VIP), nitric oxide synthase (NOS), substance P (SP) were detected by immunohistochemical methods in whole mounts of gastric fundus myenteric plexus (seven patients). Antibodies against ChAT and NOS labelled the majority of myenteric neurones identified by NSE (57.2 +/- 5.6% and 40.8 +/- 4.5%, respectively; mean +/- SD). The proportions of VIP- and SP-immunoreactive neurones were significantly smaller, constituting 19.6 +/- 6.9% and 16.0 +/- 3.7%, respectively. Co-localization studies revealed five major populations representing over 75% of the myenteric neurones: ChAT/-, 30.1 +/- 6.1%; NOS/-, 24.2 +/- 4.4%; ChAT/SP/-, 8.3 +/- 3.1%; NOS/VIP/-, 7.2 +/- 6.0%; ChAT/VIP/-, 4.9 +/- 2.6. Some similarities are apparent in the neurochemical coding of myenteric neurones in the stomach and intestine of humans, and between the stomach of humans and animals, but striking differences exist. The precise functional role of the neurochemically identified classes of neurones remains to be determined.

Aged↗
PubMed2002

[Tongue metastasis from esophageal adenocarcinoma. A case report].

Metastasis within the buccal cavity is a relatively uncommon finding observed in about 1% of malignant tumors in this region. Mandibular or maxillary bones are usually involved as well as soft tissues. Tongue involvement is rare. Secondary localizations arising from the esophagus are exceptional. These metastatic disseminations occur at advances stages. We report a case of tongue metastasis from an esophageal adenocarcinoma in a 73-year-old man who had undergone surgery for lower esophageal adenocarcinoma a few months earlier. The clinical presentation in this context was suggestive of a metastatic process confirmed at histology. Careful pathology examination is required to distinguish primary from secondary localizations and establish the diagnosis of metastasis.

Adenocarcinoma↗
PubMed1999

Interleukin 1 and interleukin 1beta converting enzyme (caspase 1) expression in the human colonic epithelial barrier. Caspase 1 downregulation in colon cancer.

BACKGROUND: Interleukin (IL) 1beta converting enzyme (now known as caspase 1) is able to process pro-IL-1beta into its active form and is involved in proapoptotic signalling. AIMS: To characterise IL-1 and caspase 1 expression in human colonic epithelial cells. METHODS: Intracellular IL-1 content (IL-1alpha and IL-1beta) was measured by ELISA in freshly isolated human normal colonocytes. Caspase 1 expression was determined both at the mRNA level using in situ hybridisation and reverse transcription polymerase chain reaction, and at the protein level by immunoblotting experiments using antibodies specific for the proform of caspase 1 and for its cleavage forms. RESULTS: Low amounts of IL-1beta were found in nearly all preparations (92%), and IL-1alpha was detected in only 45% of human colonocyte preparations. The normal colonic epithelium strongly expressed caspase 1, both at the mRNA level and at the protein level in its latent form. In contrast, caspase 1 was not expressed in colon cancer (primary colonic adenocarcinomas and cancer cell lines). CONCLUSIONS: The demonstration that the human colonic epithelial barrier is able to express caspase 1 and its substrate IL-1beta reinforces the concept that, under certain conditions, the epithelium could trigger an inflammatory reaction. In addition, the finding that caspase 1 was downregulated in colonic adenocarcinomas supports the concept that disrupted apoptosis pathways may be involved in tumour formation and/or may confer resistance to treatment.

Adult↗
PubMed1999

[Ischemic colitic in the elderly: predictive factors of gangrenous outcome].

OBJECTIVE: To better characterize the presentation of gangrenous and non-gangrenous ischemic colitis in subjects older than 60 years, and to identify risk factors of gangrenous outcome. METHODS: Retrospective analysis of 80 cases of ischemic colitis (22 male, 58 female; mean age 76.9 +/- 8.7 years) with 64 and 16 non gangrenous and gangrenous forms, respectively. RESULTS: Hematochezia and diarrhea were significantly less prevalent in gangrenous colitis compared to the non-gangrenous group (31.2% vs 81.2%, P < 0.0001 and 6.2% vs 53.1%, P < 0.0001, respectively), whereas nausea and vomiting, and hyperleukcocytosis were significantly more frequent in the former group (50.0% vs 18.7%, P < 0.01 and 93.7% vs 62.5%, P < 0.02 respectively). Hypertension (P < 0.03), angina (P < 0.05), history of cancer (P < 0.03) and age older than 90 (P < 0.002) were risk factors for gangrenous outcome. After multivariate analysis, only two independent factors were identified, i.e.: hypertension and history of cancer. These factors predicted gangrenous course in 85% of cases. CONCLUSION: Patients older than 60 years suffering from ischemic colitis are at high risk of gangrenous course if they have hypertension or history of cancer.

Aged↗
PubMed1999

[Prognostic factors of survival without clinical recurrences in medullary thyroid carcinoma: apropos of 52 operated cases].

The aim of this retrospective study on 52 operated medullary thyroid carcinoma (MTC) was to assess clinical and biochemical factors influencing survival without clinical recidive. There were 52% of familial cases. Mean age was 44 years (3 to 78 years) with 58% of women. The diagnostic was made prostoperatively in 38% of case (nodular specimen), when it was strongly suspected for 50% of patients before intervention (familial context, and/or preoperative Calcitonin (CT) levels, and/or mutation). The medial survival rate was 54 month (3 to 360 month). The absence of postoperative negativation of the CT (between 1 to 3 month) was meeting in 43% of case. Twenty one patients (42%) had presented one or several clinical relapse. At the end of the study, five patients were died in a postoperative time-limit of 22 to 110 month. The different parameters studed were: the sex, the age, the tumoral stage, the familial cases, the tum-oral size, the calcitonin levels normalisation in the three month postoperatively, and the local nodes extent. The 5-year survival rate was 90%, and the 10-year survival was 80%. The familial cases had a better pronostic than the sporadic (no death in the familial group versus 80% of 5-year survival rate in the sporadic cases). In univariate analysis, the good survival-factors without clinical recidive were: the stage I or II (p < 0,0001), the female sex (p = 0,02), the tumoral size under 10 mm (p < 0,02), the postoperative negativation of CT levels (p < 0, 0002), and the absence of cervical node extent (p < 0,0005). In multivariate analysis, only the postoperative negativation of CT-levels was a good survival-factor without clinical relapse (p < 0, 001).

Adolescent↗
PubMed1999

[MR cholangiopancreatography in choledochal cysts].

PURPOSE: To assess the value of MR cholangiopancreatography (MRCP) in the diagnosis and preoperative evaluation of choledochal cysts. MATERIAL AND METHODS: Five patients (aged between 6 days and 28 years) were investigated by MRCP, referred for ultrasonographic detection of a bile duct dilatation or a cystic structure, of antenatal diagnosis (1 case), for jaundice or abdominal pain (3 cases) or in late follow-up of a choledochal cyst surgery. Two endoscopic-ultrasonographic studies were performed. The five patients underwent surgery without preoperative biliary cholangiography. MRCP was performed using a HASTE sequence in frontal, oblique, axial planes (1,5 Tesla MR unit). RESULTS: MRCP allowed to confirm choledochal cyst, helps to specify the anatomical type (2 type I, 3 type II), detects choledocholithiasis (3 cases). Anatomic correlation was perfect. MRCP allowed to exclude gastrointestinal duplication. Anomalous junction of the pancreaticobiliary duct was found in one case. CONCLUSION: MRCP diagnoses choledochal cysts, specifies type, helps surgery and can avoid endoscopic retrograde cholangiography or endoscopic sonographic examinations especially for children. It may find an anomalous junction of the pancreaticobiliary duct.

Adolescent↗
PubMed1996

[Pathologic study with immunohistochemistry of 61 pancreatic endocrine tumors in 16 patients suffering from multiple endocrine neoplasia type I (MEN I). Review of the literature].

The Multiple Endocrine Neoplasia (MEN I) or Wermer's syndrome is an uncommon disease which is most often inherited and affects mainly parathyroid glands, pancreatic islets and pituitary gland. The aim of this study concerning 61 pancreatic tumors in 16 patients suffering from MEN I was to define the macroscopic, histological and immunohistochemical characteristics of these tumors. The pancreatic endocrine tumors as part of the MEN I syndrome concern multiple tumors of small size, localized most often to the pancreas's tail. In 79% of cases, these tumors have a different predominating peptidic hormonal secretion in a same patient though most of them have plurihormonal secretions. The pancreatic polyendocrinopathy detection imposes a family investigation to look for a type I polyendocrinopathy.

Adolescent↗
PubMed1995

[Post-appendectomy fistulas of the cecum. Apropos of 22 cases].

Appendicitis, usually a benign disease, can have its prognosis worsened in case of postoperative fistula. The latter occurs rarely after open appendectomy (0.133%), but accounts for 10% of the morbidity rate. The authors reviewed 22 cases of these fistulas, treated during a 24-year period (January 1970 to December 1993). The aim of these retrospective study was to precise their clinical features, to evaluate paraclinical examinations in diagnosing these complications and to give guidelines for their treatment. Fistulas occurred at day 14 in the postoperative course. In 21 case, appendicitis was severe (suppurative, gangrenous or perforated) or appendectomy quoted as technically difficult. Location of the appendix was atypical in 7 cases. Drainage of the site was performed in 17 cases at the time of appendectomy. Diagnosis was made on the aspect of the drainage fluid in 14 cases. Diagnosis workup of the fistula associated plain abdominal radiograph and abdominal ultrasonography (n = 22). Fistulography (n = 6) confirmed the clinical diagnosis of fistula, showing the leaking in all cases. Medical treatment was attempted first in 14 cases and was successful in 11 cases with a healing time from 13 to 72 days. Surgical treatment (open drainage of the site) was attempted first in 11 cases, and was mandatory in 3 other cases because of medical treatment failure: one patient died and 5 patients underwent re-operation (right colectomy in 3 cases, bypass in 1 case and re-drainage in 1 case). Fistulography in our experience, is highly reliable and is considered to be a great assistance in management of these fistulas. Medical treatment remains the best initial treatment modality. Surgery must be contemplated in case of established external fistulas, and of purulent or faecal fistulas. Nevertheless, prognosis remains poor (50% re-operation rate).

Adolescent↗
PubMed1994

[Perforation of duodenopyloric ulcers. Prognostic factors and therapeutic choices. Retrospective study of 140 patients].

The treatment of perforation of duodenopyloric ulcers varies according to the risks of immediate mortality and long-term recurrence. The authors carried out a retrospective study on 140 duodenopyloric ulcers which had been treated over a 13 year period. The study high identified 3 factors of immediate mortality. Age over 70 years, admission delayed by more than 24 h and preoperative hemodynamic shock. Global mortality in this series is 8.6% and varied between 2.3% and 66.7% according to the absence or presence of these 3 risk factors, respectively. The authors recommend a simple operative protocol guided exclusively by the risk factors for mortality. The presence of a single factor requires simple suture of the perforation. Suture of the perforation and vagotomy should be performed in the absence of risk factors.

Acute Disease↗
PubMed1994

[Technique of isoperistaltic esophageal gastroplasty. Comparative study of in vitro arterial vascularization].

Operative survival is impaired by anastomotic fistula after esophageal resection and reconstruction. Hypovascularisation of esophageal substitute is essential. Stomach is a useful esophageal substitute however proximal resection of lesser curvature compromises vascularisation of the highest point of fundus which is usually sutured to esophagus. To improve this a new S shape esophagoplasty with isoperistaltique stomach was achieved. Fifteen cadaveric stomachs were assigned to three equal groups prepared as follow: narrow J shape stomachs, large J shape stomachs, large S shape stomachs. The arterial tree was studied following injection of contrast media barium from the right gastroepiploic artery. Proximal arteries of the S shape stomachs were well filled comparing to the others. This was allowed by keeping intact the tronc of the left gastric artery branches, severing the left gastroepiploic artery close to the spleen, and dividing the proximal fundal region as a curve.

Adult↗
PubMed1993

[Lumbar hernias in adults. Apropos of 4 cases and review of the literature].

Lumbar hernias are rare (2% of abdominal wall hernias). Symptomatology consists frequently only of an arch formation seen best with the patient sitting and when coughing. In adults it is twice as frequent in women and on the left side. Acute events, dominated by incarceration of a digestive segment, particularly colic, often suggest the diagnosis (10% of cases). Diagnosis is simple when confronted with a large hernia, but difficulties arise with those less than 5 cm in diameter, often diagnosed as a lipoma or parietal tumor. Conventional radiographs and ultrasound images are usually sufficient to establish the correct diagnosis and to determine the content of the hernial sac, but computed tomography scans can provide data on the exact limits of the defect and allow evaluation of possible problems during surgical repair. Rarely congenital (10%), these hernias occur either secondary to a violent lumbo-abdomino-pelvic injury (25%) or following surgical intervention to the lumbar region (50% of cases). Small hernias can be repaired using the direct approach but larger deficits require the insertion of a reinforcing non absorbable prosthesis. Long term results, both for the 4 cases reported and those published in the literature, were assessed as satisfactory.

Adult↗
PubMed1993

[Retrograde cholangiopancreatography and endoscopic sphincterotomy for biliary lithiasis. Prospective evaluation in surgical circle].

Between January 1982 and 1987, 772 consecutive endoscopic retrograde cholangiopancreatographic examinations (ERCP) were performed in 673 consecutive patients suspected of having biliary tract lithiasis (mean age: 62.1 +/- 18.2 years). Two hundred and thirty-two were emergency procedures (30%). Endoscopic sphincterotomy was performed for common bile duct stones (CBDS) in 257 cases (38.0%), of whom 143 (55.6%) had undergone previous cholecystectomy. In 17.2% of cases, ERCP was either a complete (7.8%) or partial (9.4%) failure. In 124 patients for whom microlithiasis was not identified by sonography and who underwent operation, sensitivity and specificity of ERCP was 70% and 87%, respectively. Of 266 patients in whom ES was attempted, 96.6% were achieved and the common bile duct was cleared of stones in 72% of cases. Nineteen percent of patients required two or more attempts at extraction. After ERCP without ES, mortality and morbidity rates were 0.96 and 3.6% respectively. After ES, complications followed in 12.1% of patients and 3.9% died. Mortality and morbidity directly related to ES were 3.1% and 11.3% respectively. The most common complications after ERCP were acute cholangitis and pancreatitis, whereas after ES, acute cholangitis was the most common complication, followed by hemorrhage and duodenocholechocal perforations. These complications occurred independently of age and previous cholecystectomy but was closely related to stone clearance (P < 0.05). Seventy-one patients (10.5%) required operation. Twenty-nine patients underwent emergency surgery for complications with a mortality rate of 17%. Forty-two patients underwent elective surgery for retained CBDS after ES without any mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

[Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases].

Management of abdominal wounds is presently the subject of discussion between the partisans of routine laparotomy and those preferring "armed" surveillance. Results of study of a series of 176 abdominal wounds subjected to surgical dogma showed: that the diagnosis of non penetrating wounds (17.6%) was not always evident, due either to their anatomical localization (frontier region wounds) or to insufficient local exploration in urgent cases (6.6% of false-negatives), that the existence of serious clinical signs (50 cases) was always associated with one or more visceral lesions, requiring urgent laparotomy with a morbidity of 20% and a mortality of 8% (4 cases), that in the case of asymptomatic penetrating wounds (96 cases), routine laparotomy did nevertheless allow the diagnosis of visceral lesions in 50 cases (including 23 major lesions) but was of no utility in 46 cases (31.5% of blind laparotomies for the total series). The elevated proportion of useless laparotomies (30% in the literature), the result of a dogmatic attitude, or the risk of a delayed intervention (5 to 8%) in the series practising the selective method, led to a modification in the authors' attitude. The existence of serious signs should obviously result in a laparotomy. In their absence, and when confronted with a penetrating or doubtful (frontier region) wound, an exploratory celioscopy is proposed to ensure complete abdominal exploration, to confirm the presence or absence of penetration, to treat minimal lesions and to perform a classical laparotomy in case of evident necessity.

Abdominal Injuries↗
PubMed1992

[Gallstone obstruction of the common bile duct, a severe form of biliary lithiasis. Choice of treatment].

Collection of 10 or more stones in the extrahepatic common bile duct causes lithiasic obstruction of the CBD, a fairly rare entity observed in less than 10% of cases of bile duct lithiasis. This study is based on 35 cases recorded over 10 years, including 60% in patients aged more than 75 years. Endoscopic treatment was attempted in 28% of patients and was totally successful in one case our of four only because of insufficient removal of obstruction after sphincterotomy. Surgery, either necessary (8 cases) or systematic (25 cases) combines cholecystectomy, choledocotomy and biliary fiberendoscopy for a complete treatment minimizing the risks of residual lithiasis. While biliodigestive anastomoses prevailed (58%) during the first years of this study, external biliary drainage was most often chosen during the last 5 years. This surgery in aged patients still entails high morbidity (25%) and considerable mortality (9%). Better efficacy may be provided in the future by the combination of fiberendoscopic means and of lithotrity for aged subjects at high surgical risks.

Adult↗
PubMed1991

[Intestinal obstruction after Nissen's fundo-plication].

Nissen's fundal plication is acknowledged as the most effective procedure to suppress gastroesophageal reflux. It entails some morbidity (dysphagia, gas bloat syndrome), in which obstruction is the least frequently evoked but most severe risk. We report about 6 cases (4 children and 2 adults). The 4 children had been operated 3 times during the first few months of life, and their reflux was secondary to the cure of atresia of the esophagus in 2 cases, and caused severe apneas in 1 case, a former premature infant. In three cases, the obstruction was complicated within a few hours by intestinal ischemia causing death. In one case, the emergent insertion of a gastric tube allowed the decompression of the digestive tract and second surgery; the obstruction recurred 2 months later, with no postoperative complications. Two adults (aged 64 and 66) presented with gastric perforation 7 days and 9 months after fundal pliction; one of them died. These cases show how serious these obstructions are (4 deaths/6 cases). The emergent measure in such cases consists of inserting a gastric tube, although which may be impossible (1 case). The patients and their parents must be informed of this risk of complication and of its expressions. Prevention is based on a strictly submesocolic surgical approach, without any exposure of the small bowel.

Aged↗
PubMed1991

[Traumatic hemoperitoneum of splenopancreatic origin. Apropos of 155 cases. Can a non-surgical treatment be proposed?].

From 1985 to 1990, we treated 155 patients presenting with a hemoperitoneum secondary to a splenic or hepatic injury (diagnosis established by sonography, puncture and washout and/or laparotomy). These were 39 children and 116 young adults (average age 33 years). Fifty-eight of them (37%) suffered from multiple injuries (11 children, 47 adults). Splenic lesions were observed in 110 cases and hepatic lesions in 45. Ninety-one patients were operated, 55 in emergency and 36 later, while a watch-and-wait policy was applied to 64 (42%), with repeated clinical and complementary (ultrasound and/or CT) examinations. The indication for surgery was based on the clinical findings and the necessity of blood transfusion (more than 40 ml/kg/24 h in children, more than 2 to 5 U/24 h in adults, according to the context). This attitude allowed us to avoid operating two-thirds of the children and one third of the adults. We assess the limitations of this method.

Adolescent↗
PubMed1990

[Torsion of normal adnexa in children].

Seven cases of torsion of normal uterine adnexa are reported in children aged 4 to 15 years. In one case diagnosis was made by ultrasonography, allowing conservative treatment under coelioscopy. In the 6 other cases the necrosis of the ovary required its excision. The torsion concerned the ovary and uterine tube in 6 cases and the uterine tube alone in one. In 2 cases, the apparently healthy contralateral ovary was enlarged. From this series, the authors review the clinical and ultrasonographic features of the torsion of normal uterine adnexa. Ultrasonography should be performed in emergency as the conservation of the ovary depends on the precocity of diagnosis and treatment.

Abdominal Pain↗