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Biomedical subjects

J Devière

Publications and source records attributed to J Devière.

At least 145 records · Page 8Linked to original sources
PubMed1991

Intraductal mucin-hypersecreting neoplasms of the pancreas. A clinicopathologic study of eight patients.

Intraductal mucin-hypersecreting neoplasms of the pancreas with extreme dilatation of the main duct were studied in eight patients. They included five men and three women, aged 47-85 years. Five patients had a history of symptoms mimicking pancreatitis; four developed steatorrhea and/or diabetes. At endoscopic retrograde pancreatography, five patients showed an open ampulla filled with mucin, and six patients showed patchy filling defects in the ectatic main duct. Morphological examination showed extreme dilatation of the entire pancreatic duct in six patients and its tail segment in two patients. The duct segments filled with viscous mucin were lined by well-differentiated mucin-secreting cells, forming papillary foldings and occasionally showing cellular atypia. None of the patients had invasive tumor or metastasis. Six patients whose lesions were resected are alive and doing well (mean follow-up, 5.5 years). It is concluded that intraductal mucin-hypersecreting neoplasm is a pancreatic tumor with favorable prognosis. Because it shares many features with intraductal papillary neoplasm, a common pathogenesis of these pancreatic tumors is suggested.

Adenocarcinoma, Mucinous↗
PubMed1991

Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients.

Between January 1985 and September 1989, 75 patients presenting with severe chronic pancreatitis with distal stricture and upstream dilatation underwent stenting of the main pancreatic duct (MPD) through the major papilla (n = 54) or minor papilla (n = 21) in order to drain the predominant duct through a 10 F plastic prosthesis. All patients had undergone biliary and pancreatic sphincterotomy with a few cases of complications, and the majority (84%) also ESWL in the period from October 1987 onwards without complications. Relief of pain (94%) occurred parallel to a decrease in the MPD diameter. In a mean follow-up period of 37 months improvement of the nutrition status and relief of pain was seen. Clogging of these large plastic stents was treated by replacement or by another endoscopic or surgical procedure. Complications were treated endoscopically. Further measures necessary due to failure of stenting consisted of laterolateral pancreatico-jejunostomy in 15% of patients and placement of self-expanding 18 F metal mesh stents in 29%. There was no mortality due to surgery. It is concluded that stenting of distal strictures in the MPD can lead to rapid resolution of pancreatic pain due to ductal hypertension and is the best means for determining the cause of pain, providing an alternative to surgery. Significant improvement of a stricture by prolonged stenting is however unusual, and such patients treated endoscopically require close follow-up with stent replacement approximately once a year.

Adult↗
PubMed1991

IgA triggers tumor necrosis factor alpha secretion by monocytes: a study in normal subjects and patients with alcoholic cirrhosis.

Under endotoxin-free conditions, peripheral blood mononuclear cells and purified monocytes isolated from healthy control subjects and patients with alcoholic cirrhosis disclose elevated tumor necrosis factor alpha messenger RNA level and produce tumor necrosis factor alpha in response to stimulation by either soluble polymeric IgA or monomeric IgA bound to the surface of culture dishes but not by soluble monomeric IgA. Polymeric IgA induces tumor necrosis factor alpha secretion in a dose-dependent fashion. These results suggest that cross-linking of Fc alpha receptors on human monocytes induces the messenger RNA accumulation and the secretion of the cytotoxic and immunoregulatory cytokine tumor necrosis factor alpha. Furthermore, it is shown that lipopolysaccharide-induced tumor necrosis factor alpha secretion by peripheral blood mononuclear cells is synergistically enhanced in the presence of solid phase monomeric IgA but not in the presence of either soluble monomeric or polymeric IgA. Although increased lipopolysaccharide-induced tumor necrosis factor alpha secretion is observed at baseline in alcoholic cirrhotic patients, this synergism is also expressed in this group of patients. These observations could be of pathophysiological relevance in alcoholic cirrhosis because monomeric IgA deposits along the liver sinusoids and increased serum levels of polymeric IgA are common even in the early stages of this disease.

Female↗
PubMed1990

Excessive in vitro bacterial lipopolysaccharide-induced production of monokines in cirrhosis.

The objective of this study was to analyze monokine production by peripheral blood mononuclear cells from patients with alcoholic cirrhosis. The capacity of peripheral blood mononuclear cells and purified monocytes from these patients to produce tumor necrosis factor alpha, interleukin 1 beta, and interleukin 6 was investigated. Spontaneous production of tumor necrosis factor alpha, interleukin 6 and interleukin 1 beta was similar in cirrhotic and healthy subjects, but serum levels of interleukin 6 (less than 2 U/ml vs. 9.5 +/- 3 U/ml) and tumor necrosis factor alpha (3.1 +/- 1.2 pg/ml vs. 12.0 +/- 1.2 pg/ml) were significantly higher in cirrhotic patients. However, peripheral blood mononuclear cells or purified monocytes from patients with alcoholic liver cirrhosis, stimulated in vitro with Escherichia coli lipopolysaccharide, displayed a marked increase of tumor necrosis factor alpha, interleukin 1 beta and interleukin 6 secretions compared with healthy controls. A striking feature of this overproduction was its reversibility as assessed by allowing cells to rest in vitro without lipopolysaccharide for 1 to 7 days before stimulation. In such conditions, tumor necrosis factor alpha and interleukin 6 secretions declined to levels present in healthy subjects in whom production remained stable, whereas interleukin 1 beta secretion markedly decreased in both groups to the point where no difference could be seen. This reversible oversecretion of cytokines after lipopolysaccharide stimulation, along with the lack of abnormality of spontaneous cytokine secretion, suggests that monocytes in these patients may have undergone an in vivo activation process analogous to a priming phenomenon. The in vitro activation with lipopolysaccharide may represent the correlate of in vivo endotoxemia observed during acute events such as sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)

Cells, Cultured↗
PubMed1990

Septicemia after endoscopic retrograde cholangiopancreatography.

Clinical and bacteriological data from 55 patients who developed septicemia within 3 days after ERCP were collected. Forty-four patients presented with septicemia after therapeutic endoscopy, with incomplete drainage in forty, eight after diagnostic ERCP performed in obstructed bile ducts in another center and not followed by endoscopic therapy, and three with a normal common bile duct after diagnostic ERCP. The incidence of septicemia is significantly higher in cases of malignant obstruction than in benign obstruction (21% vs 3%; p less than 0.01), due mainly to the problems of drainage associated with tumoral infiltration. Forty-eight patients (87%) had incomplete bile duct drainage when they developed septicemia, and among the seven remaining cases, 3 had cholecystitis and 3 abscesses in the biliopancreatic area. Previous diagnostic ERCP without drainage was also clearly associated with septicemia after therapeutic ERCP. The most commonly isolated bacteria from blood and bile cultures were Pseudomonas aeruginosa and Escherichia coli. P. aeruginosa was observed mainly in patients referred from other centers after previous diagnostic ERCP, and was unusual in patients without previous ERCP. It is associated with problems in the disinfection of the scopes. Six deaths were attributed to sepsis, always in patients with incomplete biliary drainage which could not be improved. In most of the cases, septicemia after ERCP is related to incomplete bile duct drainage, and in some cases, to biliopancreatic infected collections. Careful disinfection of the endoscopes and other endoscopic devices is mandatory to avoid an unacceptably high rate of P. aeruginosa infection.

Adult↗
PubMed1990

New device for endoscopic cystoenterostomy.

A new device for endoscopic treatment of pancreatic pseudocysts is described. It aims to provide improved safety and ease of performance of endoscopic cystoenterostomy, even in difficult cases of massive compression of the intestinal wall with upper gastrointestinal obstruction. In this preliminary report, nine patients have been treated without complication.

Adult↗
PubMed1990

[Lack of predictive factors for symptomatic recurrence of Crohn disease at the site of surgical anastomosis].

Recurrence of Crohn's disease at the ileocolonic anastomosis after curative surgery is frequent. Prognostic value of several parameters at the time of surgery was studied in 37 patients to detect early symptomatic recurrence of Crohn's disease after surgery. These included patient age at the time of surgery, sex, disease duration before surgery, clinical activity index, length of resected bowel, presence of granulomas in resected bowel segment, indication for surgery, type of medical treatment before surgery, and biochemical parameters at the time of surgery (ESR, C reactive protein and serum albumin level). Symptomatic recurrence associated with endoscopic lesions at the anastomotic site was observed in 10 of 37 patients (27 percent), within one year after surgery. None of the studied parameters were able to differentiate the patients with recurrence or not.

Adolescent↗
PubMed1989

Endoscopic ultrasonography in achalasia.

Six patients with known achalasia were examined by endoscopic ultrasonography before dilatation therapy. At the level of the lower esophageal sphincter, a typical enlargement of the echolayer corresponding to the muscularis propria was observed in 5 cases. Endoscopic ultrasonography is a complementary procedure to manometry and x-ray for diagnosing achalasia. It helps differentiate achalasia from pseudoachalasia. In pseudoachalasia there is tumor infiltration.

Adult↗
PubMed1989

Percutaneous drainage of subphrenic abscesses.

Forty subphrenic abscesses were drained percutaneously in 37 patients. These abscesses were subsequent to abdominal surgery (28 patients), biliary obstruction and/or fistula (six patients), trauma (two patients) or acute pancreatitis (one patient). The procedures were usually monitored by duplex sonography and fluoroscopy (35 out of 40 cases), with an angled subcostal approach to the subphrenic space in over 85% of the cases. Forty-three drainage catheters were inserted using the Seldinger method; 37 (86%) had a size of 12 F or more, 21 were 16 F in size. Only two out of 43 catheters were double-lumen sump drains. The clinical condition improved after insertion of the catheter in all 37 patients. Definitive successful drainage, defined as hospital discharge without complementary surgery, was achieved in 32 patients (87%), without major complications. A temporizing effect was obtained in three additional patients (8%) who underwent curative surgery for the underlying process after complete drainage of the abscess. Two patients died from multiple organ failure before their abscess healed. Considerations for successful drainage of subphrenic abscesses include a good knowledge of the subphrenic space anatomy, the use of large-bore drainage catheters and the recognition and correct management of underlying enteric, biliary or pancreatic fistulas.

Adolescent↗
PubMed1989

Pancreaticoduodenal resection for pancreatic or periampullary tumors--a ten-year experience.

Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for pancreatic (44) or periampullary tumors (ampulla 18, common bile duct 9, duodenum 8). Fifty-five patients were icteric (55/79: 70%); 33 of them underwent preoperative biliary decompression (endoscopic procedures 29, percutaneous transhepatic drainage 3, laparotomy and T-tube placement. 1) After biliary drainage, bilirubin levels decreased from 12.4 +/- 1.3 mg/dl at admission to 5.1 +/- 1.1 mg/dl before surgery. Pancreaticoduodenal resection was performed within a mean of 15 +/- 13 days after biliary decompression. Twenty-seven patients had no complications, others developed one or more complications. The postoperative mortality was 5% (4/79). The influence of various clinical, biological and pathological factors on postoperative complications and long-term survival was studied. Neither jaundice nor preoperative biliary drainage had a statistically significant effect on overall morbidity and mortality. However, septic and hemorrhagic complications appeared to be more frequent with preoperative bilirubin levels above 20 mg/dl (0.05 less than P less than 0.1), while all postoperative pancreatic and biliary fistulas occurred in patients with a bilirubin level below 6 mg/dl (P less than 0.01). Biliary fistulas were also more frequent when anastomosis was performed on a non-dilated biliary duct (P less than 0.05). Overall actuarial survival was 58% at 1 year and 26% at 5 years. Node and/or contiguous tissue infiltration significantly decreased long-term survival (P less than 0.001). Seventy-one adenocarcinomas were reviewed and graded following a modified version of Klöppel's pathological classification.(ABSTRACT TRUNCATED AT 250 WORDS)

Ampulla of Vater↗
PubMed1988

Decreased proliferative activity associated with activation markers in patients with alcoholic liver cirrhosis.

Peripheral blood mononuclear cells from 15 patients with alcoholic cirrhosis (AC) and 15 matched healthy controls were tested for their proliferative response to mitogens such as PHA and con A, tumour promoter PMA and OKT3 monoclonal antibody, for their capacity to produce IL-2 and to respond to recombinant IL-2 (rIL-2). The expression of IL-2 receptor (Tac) together with two other activation markers, the receptor for transferrin (T9) and Ia antigen have also been assessed. A profound decrease of proliferative response was observed after stimulation by lectins and PMA. IL-2 production was significantly decreased (0.39 +/- 0.07 versus 0.82 +/- 0.009 units; P less than 0.001) in alcoholic cirrhosis. Resting PBMC of these patients disclosed spontaneous responsiveness to rIL-2 without requiring prestimulation with PHA as observed in healthy subjects. This abnormal response was associated with significantly increased percentages of Tac (19.4 +/- 3.1 versus 5.1 +/- 1.1%; P less than 0.001), T9 (13.6 +/- 3.3 versus 6.6 +/- 1.1%; P = 0.04) and Ia positive cells (21.4 +/- 5.4 versus 11.5 +/- 1.4; P less than 0.05) in alcoholic cirrhosis. Defective proliferative activity and impaired IL-2 production, combined with an increase of lymphocytes bearing T cell activation markers and of rIL-2 responsiveness could represent in vitro correlates for mechanisms leading to immunoregulatory disturbances in cirrhotic patients.

Adult↗
PubMedDate not supplied

Endoscopic approach to malignant biliary obstruction.

A consensus is growing among units that have experience in both endoscopic and percutaneous stenting techniques that the endoscopic approach to malignant biliary strictures is more comfortable for the patient and has fewer complications. This article describes endoscopic biliary drainage in malignant stenoses of the bile ducts and delineates the respective indications for percutaneous and endoscopic techniques. New materials have become available for endoscopic and percutaneous biliary drainage, particularly metallic stents which may provide better palliation.

Cholestasis, Intrahepatic↗
PubMedDate not supplied

Wallstent misplacement into the paraumbilical vein during TIPS from the left hepatic vein: correction by placing a second stent through the mesh of the first stent.

During a TIPS procedure using the left hepatic vein approach, a Wallstent was misplaced into a dilated paraumbilical vein instead of the left portal vein. The correct shunt direction from the left portal vein to the left hepatic vein was restored by coaxially inserting a second Wallstent through the stretched mesh of the misplaced stent. To prevent such stent misplacement, it seems useful to emphasize the importance of maintaining the exchange guidewire within the distal portion of the splenic or mesenteric vein throughout dilatation and stenting of the liver parenchyma.

Angioplasty, Balloon↗
PubMedDate not supplied

Transcatheter embolization of pseudoaneurysms complicating pancreatitis.

PURPOSE: To evaluate the therapeutic role of angiography in patients with pseudoaneurysms complicating pancreatitis. METHODS: Thirteen symptomatic pseudoaneurysms were treated in nine patients with pancreatitis. Eight patients had chronic pancreatitis and pseudocyst and one had acute pancreatitis. Clinical presentation included gastrointestinal bleeding in seven patients and epigastric pain without bleeding in two. All patients underwent transcatheter embolization. RESULTS: Transcatheter embolization resulted in symptomatic resolution in all patients. Rebleeding occurred in two patients, 18 and 28 days after embolization respectively, and was successfully treated by repeated embolization. One patient with severe pancreatitis died from sepsis 28 days after embolization. Follow-up was then available for eight patients with no relapse of bleeding after a mean follow-up of 32 months (range 9-48 months). CONCLUSION: Transcatheter embolization is safe and effective in the management of pseudoaneurysms complicating pancreatitis.

Acute Disease↗
PubMedDate not supplied

Endoscopic biliary drainage in chronic pancreatitis.

Between April 1982 and March 1988, 25 patients with chronic pancreatitis presented with biliary stenosis and significant cholestasis. They were treated by endoprosthesis placement. Nineteen patients had jaundice, and, initially, seven had cholangitis (including three with hepatic abscesses). ERCP was successful in all 25 patients. Cholangitis, cholestasis, and jaundice resolved in all cases after stent placement. Two patients died in the 2 months after treatment. Complete follow-up (mean duration, 14 months, range 7 to 42 months) was available for 19 of the 23 remaining patients. Migration of the stent occurred in 10 patients and stent blockage in 8 patients, with relapsing cholestasis (N = 12), cholangitis (N = 4), or without symptoms (N = 2). Only three of these patients are now asymptomatic without a stent in place after 12 to 72 months. In all of the other cases, stents have been replaced or patients have been treated by surgery. We conclude that endoscopic biliary drainage is an effective treatment for resolving cholangitis or jaundice in patients with chronic pancreatitis and biliary stenosis, but that the results of definitive endoscopic drainage for these patients are less satisfactory because resolution of the stricture after removal of the stent is rarely obtained.

Adult↗