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Biomedical subjects

J Marescaux

Publications and source records attributed to J Marescaux.

At least 19 recordsLinked to original sources
PubMed1995

[Colonic diverticular haemorrhage].

Bleeding related to diverticular disease occurs in 10 to 30% of patients suffering from diverticular disease. Haemorrhage varies from occult to massive bleeding. Bleeding is related to mechanical aggression of the artery in the wall of a diverticulum. Bleeding prevalence is not exactly known. In 1 to 7% of cases, massive bleeding is observed; diverticular disease is thus the most common cause of major lower gastrointestinal tract haemorrhage, followed by angiodysplasias. Although 95% of diverticular involve the sigmoid colon, more than 50% of bleeding diverticular occur in the right colon. Classically, presentation of bleeding is sudden without any inflammatory diverticulitis. Bleeding from diverticula stops spontaneously in 80% of cases. For definite diagnosis, selective abdominal angiography during bleeding phase is the procedure of choice. Other explorations are not contributive. Most haemorrhages have a benign outcome. Massive, persistent or recurrent haemorrhage should benefit from surgical procedure. In case of active bleeding in which diverticular origin has been validated by angiography, intra-arterial perfusion of vasopressor agents may be attempted, as a temporary treatment before delayed colonic resection. Segmental colectomy usually prevents recurrent haemorrhage when site of diverticular bleeding has not been identified with precision by angiography. Subtotal colectomy should only be used in the last resort. Extent of surgery will be based on likely origin of bleeding.

Diverticulum, Colon↗
PubMed1994

Experimental pancreatic cancer in the rat treated by photodynamic therapy.

Selective histological necrosis of experimental pancreatic carcinoma by photodynamic therapy (PDT) has been successful with haematoporphyrin derivatives and phthalocyanine as photosensitizers. This report describes the feasibility of PDT with pheophorbide A as the photosensitizer to treat azaserine-induced pancreatic rat carcinoma and analyses survival of the animals. An organ distribution study 24 h after pheophorbide A administration (9 mg/kg intravenously) gave a selectivity ratio of 13.5:1 between tumour and surrounding tissue. Light of 660 nm and 100 J/cm2 induced selective necrosis of the tumour. Six of nine rats were cured in 120 days whereas all 36 control animals died within 35 days (P < 0.01). The pancrease and hepatic pedicle were relatively unaffected by PDT, but the duodenum was injured.

Adenocarcinoma↗
PubMed1994

Laparoscopy: an alternative to surgery in patients treated with continuous ambulatory peritoneal dialysis.

Fifteen laparoscopic abdominal operations were performed in 14 patients treated by continuous ambulatory peritoneal dialysis for chronic renal failure. Celioscopic exploration of the abdomen and subsequent operation displayed several advantages specific to the method: identification of the etiology of scrotal dialysate outflow was achieved in 4 cases, peritoneal dialysis catheter salvage during laparoscopic cholecystectomy in 1 case, abdominal exploration during occurrence of peritonitis in 3 cases, and catheter dysfunction or abdominal examination before catheter implantation in 7 cases. The laparoscopic procedure allows early resumption of peritoneal dialysis after surgery, hence avoiding the need for transient hemodialysis. Nevertheless, it seemed unable to offer a salvage capability of infected catheters through extensive abdominal washing. Laparoscopy has been reported to decrease postoperative pain and disorders of ventilation, allowing for rapid recovery of social and professional activities following this minimal invasive surgical technique. Laparoscopy is a novel technique which enables precise diagnosis and surgical operations in patients treated by continuous ambulatory peritoneal dialysis.

Abdomen↗
PubMed1994

Implication of cholecystokinin in pancreatic adaptation after biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), a bariatric surgical procedure, leads to a malnutrition-induced general visceral atrophy except for the pancreas. This work investigates the implication of cholecystokinin (CCK) in the exocrine pancreatic adaptive process using a plasma CCK assay and the CCK receptor antagonist CR 1409. No significant reduction in weight and DNA content of the pancreas was noted 36 days after BPB, while a strong decrease in protein, enzymes and RNA contents indicating cellular hypotrophy became apparent. CR 1409 treatment strongly depressed pancreatic weight and its DNA content in BPB animals, suggesting an additional hypoplasia; however, the reduction in pancreatic enzyme content was not aggravated. BPB increased plasma CCK concentrations by 160%, unrelated to CR 1409 treatment. These results indicate that: (1) CCK is involved in the pancreatic adaptive response after BPB in rats, and (2) in the context of a protein malnutrition state, CCK dissociates its pancreatic growth and enzymatic effects, favouring the former.

Adaptation, Physiological↗
PubMed1994

[Implantable insulin pump: the first step towards an artificial pancreas].

Recent improvements in miniaturization of implantable pumps and the ability of their control by teletransmission allow implantation of autonomous pumps which administer insulin into the peritoneal cavity. Fifty-six patients with diabetes mellitus underwent implantation of 66 pumps with a mean function life of 21.8 months per patient. No patient has died to date. Tolerance of implanted components was good. Morbidity was limited to local events, in this series 4 cutaneous erosions, two of them leading to final pump explantation. Mean global blood-sugar, pre- and post-prandial blood-sugar, and glycosylated hemoglobin assays were all lower versus pre-implantation assays. A statistically significant difference was demonstrated regarding mean global blood-sugar. The frequency of severe hypoglycemia incidents (2 in our series) and biochemical hypoglycemia (blood-sugar < 65 mg/100 ml) was decreased, representing a major benefit of the technique. The patients well-being and quality of life were notably improved. Implantable insulin-pump may be offered as alternative treatment to conventional insulin-therapy, especially in cases of diabetes which are difficult to control and particularly in cases with frequent hypoglycemic malaise.

Adult↗
PubMed1994

[Primary leiomyosarcoma of the femoral vein. Therapeutic aspects].

Leiomyosarcomas are exceptional in peripheral veins. Clinical signs are not specific, secondary to effects of the tumoural mass. Computed tomography and MRI give a precise topographic diagnosis. Pathology examination on biopsy or surgical specimens establishes the histological diagnosis. Therapeutic management must take into account local tumour recurrence and metastasis. Surgical exeresis should be wider than the tumour's pseudocapsule to include micrometastases neighbouring the primary tumour. Post-operative radiotherapy (55 to 70 Gy) and chemotherapy should follow. With this management scheme, local disease is controlled in 85% of the cases with a 5-year follow-up. Local or metastatic extension usually occurs within the first 3 years. Management of venous sarcomas thus requires a multidisciplinary cooperation between the surgeon, the radiotherapists and the chemotherapist.

Adult↗
PubMed1993

Trophic and enzymatic adaptation of the intestine to biliopancreatic bypass in the rat.

Biliopancreatic bypass (BPB), the exclusion of a duodenojejunal loop from the digestive continuity, has been proposed as a bariatric procedure for treatment of morbid obesity. The present study in rats investigated the effect of this surgical procedure on the mucosae of the ileum directly anastomosed to the stomach, and of the jejunum irrigated only by biliopancreatic secretions. The proximal part of the ileum adapted by two-fold increases in its mucosal mass, total protein and RNA content; DNA content was four-fold higher than in sham-operated animals. There was a correlated increase of mucosal enzyme content, except for lactase. In the distal ileal mucosae, a slight, transient augmentation of mucosal mass, protein, DNA and RNA content was observed which tended to compensate for the shortening of the functional gut. No morphological changes were found in the excluded loop, probably because of an endoluminal stimulation by biliopancreatic secretions. Thus, in BPB, biliopancreatic secretions seem to exert trophic effects on the intestinal mucosa, but they are less potent than the endoluminal nutrition that restores the oral-aboral mucosal gradient.

Adaptation, Physiological↗
PubMed1992

Experimental photodynamic therapy with a copper metal vapor laser in colorectal cancer.

In an attempt to define the best conditions for an adjunctive treatment of residual colonic microtumors by photodynamic therapy (PDT), an experimental model has been defined. S.c. HT29 colonic-cancer-cell tumors grown in nude mice were used and, 48 hr after i.p. administration of 30 mg/kg Photofrin (PH), laser illumination was performed with 75 or 150 Joules/cm2. The efficiencies of 2 lasers, the classically used rhodamine laser (RL) and a copper metal vapor laser (CMVL), were compared. The effects of PDT were assessed by histological and immunocytochemical (detection of a digestive enzyme, dipeptidyl-peptidase IV, as a marker of cell viability) follow-up and by the growth curve of the tumors after illumination. We conclude that, although the depth of necrosis resulting from PDT was nearly 3 mm at 75 J/cm2 and nearly 4-5 mm at 150 J/cm2 with both lasers, complete necrosis was obtained only with the CMVL at 150 J/cm2 (in 50% of the tumors). Under the other conditions, a layer of unaffected cells persisted at the pole opposite to laser illumination, resulting in growth curves lower than but parallel to those of the controls. Analysis of drug concentrations in the tumors and various organs, 48 hr after injection, i.e., at the time of laser illumination, revealed the presence of 21 micrograms/g dry weight PH in the tumors. The tumor vs. host-organ ratios were equal to or higher than 1 for the small bowel, colon, stomach, lung, skin and muscle. In contrast, the ratios were below 1 for the spleen, pancreas, kidney and liver.

Animals↗
PubMed1992

In vitro resistance of artificial connective tissues to human bile and pancreatic juice.

The resistance of connective tissue generated from elastin, placenta extracts and human collagen was tested by in vitro incubation with bile and pancreatic juice to investigate the potential use in human digestive surgery. The resistance, determined by macroscopical and microscopical examinations, has been directly compared to those of bovine collagen matrices (Spongel, Pangen, Helistat, Translagen). Only the compact and cross-linked human collagen patch resisted both bile and pancreatic juice. All other biomaterials tested dissolved either in bile or in pancreatic juice. The in vivo behaviour of this new human collagen matrix and its involvement in gastrointestinal wound healing must now be investigated.

Animals↗
PubMed1992

[Cancer of the stomach: for a revised strategy].

The "revisionist" approach to therapy of gastric cancer needs a previous demonstration of the qualitative comparability of Japanese and western treatments of gastric adenocarcinoma. Early gastric cancer is far more common in Japanese than in Occidentals, but its character is the same, and for identical stages and treatments, the prognosis is the same. But many western studies show serious methodological deficiencies (staging, anatomopathological examination...), as well as a serious lack of interest in adjuvant therapy, a potential source of progress. We propose a 4-point therapeutic approach inspired by the Japanese example: a greater methodological rigor, standardization of lymphadenectomies, the definition of therapeutic subgroups to receive optimal treatments, the development of new adjuvant treatments.

Chemotherapy, Adjuvant↗
PubMed1992

[Validation of the measurement of hepatic volume by three-dimensional computed tomography].

The aim of this work was to verify experimentally the reliability of 3D CT scan in measuring hepatic volumes. Eight livers were dissected from corpses. The referring liver volume was determined by measure of its hydric shift. The correlation coefficient R was 0.93 (p < 0.001) on 5 mm/5 mm 3D sections, 0.92 (p < 0.001) on 10 mm/10 mm 3D sections and 0.94 (p < 0.0006) on 5 mm/10 mm 3D sections. The paired t-test also showed a 5% risk correlation between the two measurements. Although in vivo imaging is slightly different from in vitro, 3D CT scan seems to be a reliable method to determine an hepatic volume without increased X-ray irradiation.

Humans↗
PubMed1992

[Is cholecystectomy by celiovideoscopy dangerous in the initial period? Prospective study of 100 initial cases].

The aim of this study was to prospectively study the complication rate of our 100 initial laparoscopic cholecystectomies. The ultimate goal was to obtain a morbidity rate comparable to open cholecystectomy. No major complications were noticed. The conversion rate to open cholecystectomy was 8%, slightly higher in comparison with the literature. Absence of major complications could be explained by: a) indications limited to symptomatic non complicated cholelithiasis; b) assistance at the beginning of our experience of gynecologists used to laparoscopic techniques; c) conversion to open cholecystectomy in case of technical difficulties. Application of these principles allows the digestive surgeon to start laparoscopic cholecystectomy without submitting the patient to additional risks.

Adolescent↗
PubMed1991

[Incidental disclosure of an adrenal tumor. Diagnostic and therapeutic procedure].

Among upper abdominal computed tomography (CT) scans, 0.6 per 1000 fortuitously reveal an adrenal tumour, an "image pathology" now known as "adrenal incidentaloma". Should the clinician avoid useless, iatrogenic surgery or run the risk of failing to identify a malignant adrenocortical tumour? We outline a clinical procedure aimed at distinguishing between solid vs liquid, secreting vs non-secreting and primary vs metastatic tumour. Nevertheless, in the end the diagnosis may be uncertain, in which case tumour size becomes the deciding factor. For tumours of less than 3 cm close surveillance is advocated, whereas surgery is necessary for tumours larger than 3 cm; for tumours in between these sizes only the individual clinician can decide.

Adrenal Gland Neoplasms↗