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Biomedical subjects

J F Lefebvre

Publications and source records attributed to J F Lefebvre.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Endoscopic retrograde cholangiopancreatography and biliary prosthesis].

Endoscopic retrograde cholangio-pancreatography (ERCP) confirms the diagnosis of obstructive jaundice and sometimes provides the histological proof that the stenosis is due to cancer. Palliative treatment of biliary and pancreatic cancers is indicated when the extension of the tumour is such that it precludes any oncologically satisfactory excision, in patients at high operative risk, when jaundice recurs after surgery and in cases of biliary metastases from distant cancers. Cancers located below the hilum are usually easily treated by endoscopic insertion of a biliary stent, whereas hilar cancers extending to the bifurcation often require combined endoscopic and percutaneous techniques to drain all liver segments. The most frequent of early complications of biliary stents is cholangitis, notably in hilar cancers. Late complications, notably obstruction of the stent, can be reduced by using expandable metal stents.

Biliary Tract Neoplasms↗
PubMed1991

Common bile duct and intrahepatic stones: results of transhepatic electrohydraulic lithotripsy in 50 patients.

Percutaneous, transhepatic, intracorporeal, electrohydraulic shock wave lithotripsy was performed in 50 patients after failure of endoscopic treatment (n = 43) or directly in patients with a strictured hepaticojejunostomy (n = 7). Twenty-seven patients had common bile duct stones; 23, intrahepatic stones. Three steps were used: A transhepatic bilicutaneous fistula was created, a wide communication between the bile duct and the gut was established, and contact shock wave lithotripsy was performed under endoscopic guidance. Afterward, 46 patients were free of stones. In four patients with diffuse intrahepatic lithiasis, only 75% of stones could be cleared. Severe complications, seen in 11 patients (hemobilia necessitating transfusion [n = 6], bile duct perforation resulting in cholangitis [n = 3], acute pulmonary edema [n = 1], and hemothorax [n = 1]), were fatal in four patients; all occurred early in the study. The authors modified their technique by dilating the biliary tract in two sessions 3 days apart, waiting 6 days for the tract to mature, and then introducing the cholangioscope directly through the skin, significantly reducing complications and mortality (P less than .005).

Adult↗
PubMed1991

Growth hormone deficiency following radiation therapy of primary brain tumors in children.

The medical records of 123 patients treated for brain tumors at Children's Hospital and Medical Center, Seattle, Washington, between 1985 and 1987 were reviewed. The endocrinological complications of radiation therapy and the effectiveness of growth hormone (GH) replacement therapy were assessed. These were the first 2 years after synthetic GH became available. The disease pathology was confirmed at craniotomy or biopsy in 108 patients. Ninety-five children completed radiation therapy and 65 of these were alive at the time of review; these 65 children represent the study population. The most common tumor types were medulloblastoma, craniopharyngioma, and ependymoma. Endocrine evaluation was initiated with changes in the patients' growth velocity. Patient workup included skeletal x-ray films for determination of bone and analysis of thyroxin, thyroid-stimulating hormone, and somatomedin-C levels. Following 1-dopa and clonidine stimulation, provocative studies of GH levels were performed. Growth hormone failure and short stature were observed in 26 children, most commonly in the 2nd year after tumor treatment. Eight patients with GH failure were also hypothyroid. Hormone replacement therapy was initiated with recombinant GH, 0.05 mg/kg/day, and all children so treated showed an increase in height, with eight patients experiencing catch-up growth. There were no complications of therapy or tumor recurrence. Studies of baseline bone age and somatomedin-C levels on completion of radiation therapy are recommended. Comprehensive endocrine studies should follow changes in the patients' growth velocity. With early GH replacement, catch-up growth is possible and normal adult heights may be achieved.

Adolescent↗
PubMed1991

[Endoscopic and transhepatic intubation of malignant bile duct strictures for postoperative jaundice].

Out of 625 patients referred for stenting for a malignant stricture of the biliary tract, 97 (15.8%) had undergone previous surgery. Resection had been performed in 43 cases, by-pass in 15, surgical stenting in 11, laparotomy in 28. The stricture was located in the porta hepatis in 48 patients (49.5%) in the middle common bile duct (CBD) in 47 (48.5%) and juxtapapillary in 2 (2%). Endoscopic retrograde transhepatic stenting was successful in 51 patients (52.5%). Percutaneous transhepatic stenting was successful in 41 cases out of 46 (85%) and in 5 cases, only external drainage was possible. A 75% reduction in serum bilirubin was observed in 78 patients (81.5%) and normalization was observed in 66 (90%) who survived more than one month. The complication rate was 31.3% in the endoscopic group and 47.7% in the percutaneous transhepatic group, with a mortality related to early complications of 9.8% and 19.6% respectively. The higher complication rate of transhepatic stenting is at least partially related to an unfavourable selection of patients in this group: failures of endoscopic stenting, high frequency of hilar strictures. The mortality at D 30 was 24%, significantly higher in hilar strictures than in middle CBD strictures (p less than 0.02). A late obstruction of the stent occurred in 43 patients (58%) after an interval of 103 +/- 52 days, and endoscopic retreatment was possible in 65% of cases. The median survival was 153 days in subhilar strictures and 104 days in hilar strictures. These results justify considering the possibility of palliative stenting after failure of a surgical treatment especially in peri-ampullary and middle CBD strictures.

Aged↗
PubMed1990

[Endoscopic treatment of common bile duct calculi].

The endoscopic treatment of calculi of the main biliary duct (CMBD) has been performed in France since 1974. One of us (Cl. L.) published his results with a series of 323 patients in 1979. The stones were extracted in 86.5% of all cases, the failures being caused by the impossibility to perform endoscopic sphincterotomy (ES) in 4.3% of cases or to extract the stones in 9.2%. Since that date, a number of factors helped improving the effectiveness of endoscopic treatment: the increasing experience of the surgeons, the improvement of endoscopes, especially more appropriate optics (wide angle and 15 degrees retrograde vision) and the endoscopic approach of the biliary tract, the use of intraoperative radiology allowing access to the biliary tract in all cases, and the development of extra- and intracorporeal lithotrity solving the problem of stones that cannot be extracted by conventional means. This work is aimed at demonstrating the current possibilities of the endoscopic treatment of lithiasis of the CMBD in a Hospital using plain radiology and lithotrity.

Ethers↗
PubMed1990

[Dissolution of gallbladder lithiasis with methyl tert-butyl ether (MTBE). Preliminary results in 9 cases].

Instillation of Methyl tert-butyl ether in the gallbladder permits the dissolution of cholesterol stones. Percutaneous transhepatic puncture of the gallbladder is the currently used approach; but shortcomings of this procedure could make the transpapillary cannulation of the cystic duct preferable. The reproducibility of this procedure, however, is not established. "In situ" dissolution is useful in cases of multiples stones which are not amenable to treatment with extra corporeal shock wave lithotripsy (ESWL). It can also be complementary to standard ESWL by promoting rapid disappearance of stones fragments. Preliminary results obtained in 9 patients suggest the necessity of rigorous selection criterias particularly regarding the chemical nature of the stones.

Adult↗
PubMed1989

Indications for cholangioscopy.

Cholangioscopy permits new diagnostic and therapeutic procedures. It can be performed via the peroral route when anatomical conditions are suitable. This procedure was attempted in 6 cases (lithiasis in 5, malignant stenosis in 1): cholangioscopy proved possible in 4 cases, and lithotripsy was successful in 2 cases out of 3. Percutaneous transhepatic cholangioscopy was performed when peroral cholangioscopy was not possible (non-accessible papilla, hepatico-jejunostomy), or failed. In 17 patients with common bile duct (CBD) stones, unextractable by conventional procedures 14 underwent a cholangioscopy with electrohydraulic lithotripsy. Sixteen had complete clearance of the CBD. Cholangioscopy was attempted in 18 patients with intra-hepatic lithiasis. Lithotripsy was necessary in 10 cases and stenosis dilatation in 8. Results were excellent in 15 patients, and good in 3 with diffuse intra-hepatic lithiasis. In the case of lithiasis, the complication rate of the procedure was 29.5% and 27.7% for CBD and intrahepatic stones, respectively, and the mortality rate was 8.5% (n = 3). These complications (bleeding and cholangitis) are closely related to the percutaneous route. In malignant stenosis (n = 5), cholangioscopy was performed for diagnostic purposes in one case, extraction of a stent in one case and endobiliary laser treatment in 3 cases.

Adult↗
PubMed1987

[Extracorporeal lithotripsy. Preliminary results in 5 patients with calculi of the common bile duct].

Extracorporeal lithotripsy was performed in 5 patients whose stones in the main bile duct could not be extracted despite wide endoscopic sphincterotomy, conventional extraction techniques (basket and balloon catheter) and attempts at mechanical lithotripsy. Fragmentation of the stones was obtained in one session in 4 patients. The fragments were spontaneously expelled in 2 patients, while additional endoscopic manoeuvres (mechanical lithotripsy, extraction after installation of a temporary prosthesis) were necessary in the other 2 patients. Failure in the 5th patient was due to the impossibility to focus the point of convergence of the shock wave on the stones. No complication related to the technique was observed.

Aged↗
PubMed1986

[Pancreas divisum: clinical and therapeutic study in man. Apropos of 87 cases].

In order to evaluate the responsibility of pancreas divisum in the occurrence of pancreatitis, we studied retrospectively 1,808 endoscopic retrograde pancreatograms. Eighty-seven pancreas divisum (4.8 p. 100) were found in 50 males and 37 females, mean age 53.3 +/- 16.8 yrs. Acute pancreatitis was significantly more frequent (p less than 0.001) in this group (19.6 p. 100) than in the patients with fused pancreas (4.3 p. 100). The difference was also significant (p less than 0.01) for idiopathic recurrent acute pancreatitis. Histologic lesions in the dorsal pancreas were in favor of a retentional mechanism of pancreatitis. Sphincterotomy of the accessory papilla, proposed to improve the drainage of the dorsal pancreas, was performed in 11 patients (10 endoscopic, 1 surgical). This treatment, repeated in case of secondary stenosis of the accessory papilla, was successful in 5 out of 8 patients with acute pancreatitis followed up from 12 to 30 months. After reviewing the literature, secondary stenosis of accessory papilla was found significantly less frequently (p less than 0.05) after surgical sphincterotomy or sphincteroplasty (4 out of 46, 8.6 p. 100) than after endoscopic sphincterotomy (6 out of 22, 27.2 p. 100). Treatment, preferentially surgical, should be proposed only to patients with idiopathic recurrent pancreatitis before constitution of chronic non reversible pancreatitis.

Acute Disease↗
PubMed1985

Establishment of hybridomas secreting monoclonal antibodies to Chlamydia psittaci.

Eleven stable anti-Chlamydia hybrid clones by fusions between X63-Ag8653 myelomas and immune splenocytes from Chlamydia psittaci immunized F1 (C57BL6 X BALB/c) mice have been established which react with the 12 reference Chlamydia strains (seven C. trachomatis and five C. psittaci. Ten of these monoclonal antibodies are directed against the genera-specific epitope (40,000 MW component) for which prolonged immunization seems to be responsible.

Animals↗
PubMed1983

[Cholestatic hepatitis. Presumptive role of ticlopidine].

A seventy-one-year-old woman presented with jaundice (total bilirubinemia 91 microM, conjugated bilirubinemia 76 microM) and cytolysis (ALAT greater than 6 N) after ten days of pentoxifylline-ticlopidine combination therapy. Blood count was normal excepting transient anemia. Protein electrophoresis was normal. Jaundice resolved 10 days after both drugs had been discontinued. Viral serology (B, A, nonA-nonB, mononucleosis, cytomegalovirus, herpes simplex virus) was negative. Ultrasonography and cholecystography were normal. Responsibility of a drug is therefore likely and we are inclined to incriminate ticlopidine as two similar cases have previously been observed.

Aged↗
PubMed1980

Modifications of the envelope of Chlamydia psittaci during its developmental cycle: freeze-fracture study of complementary replicas.

Examination of complementary replicas obtained by freeze-fracture of Chlamydia psittaci revealed, at the level of the plasma membrane, a progressive differentiation of "crate-like formations," which likely correspond to transmembranal pores. Recognition of "early" and "late" stages observed in the intermediate bodies permitted detailed study of the developmental cycle of this chlamydia.

Cell Cycle↗