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Biomedical subjects

J Maurel

Publications and source records attributed to J Maurel.

At least 55 records · Page 3Linked to original sources
PubMed1995

Participants' characteristics in a French colorectal cancer mass screening campaign.

BACKGROUND: Participation by the target population is clearly a key element in the success of mass screening programs for colorectal cancer. In France, involvement of general practitioners in test distribution is essential to reach a satisfactory participation rate, but other forms of recruitment also have to be organized. The aim of this study was to determine the influence of demographic characteristics such as sex, age, and place of residence on the participation rate in a French mass screening according to different recruitment methods. METHODS: The Hemoccult IIR test was proposed in three consecutive ways: spontaneously by general practitioners and occupational doctors during appointments (phase 1), by postal invitation (phase 2), and finally by direct mailing of the test (phase 3). The target population consisted of 11,947 people between 45 and 74 years of age, living in a district of the French county of Calvados, between March 1991 and April 1993. RESULTS: The overall participation rate was 51.3%. Forty-nine percent of all the tests were done during phase 1, 31% during phase 2, and 20% during phase 3. The overall participation rate varied essentially according to the place of residence, from 65.5% in urban areas and 48.9% in intermediate areas to 27.7% in rural areas. The overall participation rate was also higher for females (57%) than for males (45%) and for those 60 years and older (53.9%) than for those below this age (49.2%). The proportion of tests done during phase 1 was lowest among the youngest and the oldest age groups (37.5% in the 45- to 49-year class and 45.2% in the 70- to 74-year class) and among people living in the rural environment (respectively 55.3%, 45.5%, and 35.9% in urban, intermediate, and rural areas). CONCLUSIONS: This study shows that place of residence strongly influences the global participation rate in mass screening for colorectal cancer in France, whereas sex and age have little influence. Recruitment methods complementary to distribution by general practitioners must be organized, especially for the youngest and oldest age groups (45-49 years and 70-74 years) and above all for people living in rural areas. The social, cultural, and psychological reasons for these differences remain to be investigated, with the aim of adapting mass screening strategies to the different population groups.

Aged↗
PubMed1995

Haemoccult test properties according to type and number of positive slides in mass screening for colorectal cancer.

Despite encouraging results from recent studies, there is still no consensus to undertake mass screening using the Haemoccult test in the general population. The success of mass screening for colorectal cancer depends among other things on Haemoccult test properties. In on-going screening programmes, the Haemoccult test consists of six slides and a test is considered positive if at least one slide is coloured. The aim of this work was to study the influence of the type and number of positive slides on the Haemoccult test's positive predictive value and characteristics of screened lesions. This work focuses on 63,958 first tests in a mass screening programme in Calvados (France) among people aged 45-74 years. There was a linear relation between the positive predictive value for cancer or an adenoma larger than 1 cm and the number of positive slides (P < 10(-4)). The positive predictive value for cancer or large adenoma was significantly higher when 4-6 slides were positive (44.3%) than when only 1-3 were positive (19.1%) (P < 10(-4)). In this latter group, the subjects in whom tumours were detected were younger and had significantly less extensive cancers. Borderline tests (no slides positive and at least one slide with a blue coloration confined to the edges) had a positive predictive value for cancer or an adenoma larger than 1 cm no different to that of tests with 1-3 positive slides. Subjects with borderline results were markedly younger than the others and had less extensive cancers and rectal localisation more often than the others. Our results suggest that (1) increasing the number of positive slides required to declare a test positive leads to an increase in the positive predictive value but is not to be recommended because of the sensitivity of the test and (2) considering borderline Haemoccult tests as positive in on-going and future mass screening campaigns would allow an increase in the sensitivity of the test, especially for rectal cancer and low extensive tumours without any decrease in its positive predictive value.

Aged↗
PubMed1995

[Treatment of cancer of the rectum. Practical survey based on 7 French departments in 1990].

OBJECTIVES AND METHODS: Therapeutic modalities in rectal cancer were analyzed in a French population based study. This work reviewed all the new cases of rectal adenocarcinoma diagnosed in a one-year period from January 1st to December 31st 1990 among the population of 7 provinces. Thus, 427 new cases of rectal cancer were included in a data base (EUROCARE). The main goal of this study was to provide an up-to-date, unbiased evaluation of the different treatments of rectal cancer according to its stage when diagnosed. The aim was also to point out differences in therapeutic management between these different geographic areas. A three-stage clinico-pathological staging was used to minimize stage migration bias. RESULTS: 77.8% of the patients underwent a rectal excision; among them, 53.9% had a sphincter saving procedure. Adjuvant radiotherapy was associated to rectal resection in 46.2% of the patients and was pre-operative in 45.9%. Only 13.7% of patients had chemotherapy. CONCLUSIONS: We demonstrated a significative difference of therapeutic modalities between these different french geographic areas concerning adjuvant radiotherapy and chemotherapy. This work supports the need and the value of population-based study for clinical management, prognostic evaluation and evaluation of public health issues.

Aged↗
PubMed1994

[Mesentric venous thrombosis. Risk factors, treatment and outcome. An analysis of 18 cases].

Eighteen patients with an acute thrombosis of the splanchnic veins were reviewed. Most of apparently idiopathic cases of splanchnic vein thrombosis are related to an increased coagulation related to a congenital or acquired defect of haemostasis. The aim of this study was to assess the effects of a new and effective treatment. Nine male and 9 female patients (range of age: 19 to 81 years) experienced a mesenteric venous thrombosis. There were 14 mesenteric vein thromboses with infarction, two transient mesenteric venous ischaemias without bowel infarction and two acute thromboses of the splanchnic veins without bowel ischaemia. A coagulopathy was detected in seven patients: oral contraception, protein C (PC) or antithrombin III (AT III) congenital deficiencies, acquired deficiency of AT III, PC and protein S (PS), polycythaemia in the post-partum period and primary myeloproliferative disorder. No coagulopathy was associated with thrombosis in eight cases: mesenteric haematoma, splenomegaly, cirrhosis, appendicectomy, cholescytectomy, chronic heart failure, treatment with beta-adrenergic receptor antagonist and digitalis, stenosis of the portal anastomosis after liver transplantation. Twelve patients required surgery: eight intestinal bowel resections with immediate anastomosis, four resections without immediate anastomosis. Only one patient underwent a second look for a repeat bowel resection. No death occurred in the early postoperative period and 17 out of 18 patients were alive after 12 years. An oral anticoagulant therapy was undertaken from two months to seven years. However, three patients suffered a recurrent thrombosis. Two of them required a long-term anticoagulation. Six patients experienced a portal hypertension and oral anticoagulants were discontinued in three of them because of bleeding oesophageal varices. Six patients were treated only by unfractionated heparin (UFH) or low molecular weight heparin (LMWH) followed by oral anticoagulants. After laparotomy, two were only treated with UFH without any bowel resection, as mesenteric venous ischaemia was too extensive. These observations suggest that the choice between an appropriate medical or surgical treatment is important and must be discussed. Since 1989, the therapeutic choice has been modified by ultrasonography and contrast enhanced computed tomographic scan which confirms diagnosis, allows to follow up and check the effects of anticoagulation and to choose the time for surgery. When the diagnosis is established and the patient's risk is low, the IU . kg(-1) . d(-1) to obtain an antifactor Xa activity between 0.3 and 0.6 antiXa IU mL(-1). When the diagnosis is uncertain and the patient's risk if high a laparotomy is required.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Post-traumatic hemobilia. How to treat? Apropos of a case].

Severe hemobilia after blunt hepatic trauma is one of the limits for a conservative medical treatment. Urgent percutaneous highly selective embolization of the bleeding vessel is the treatment of choice today. Failures of radiological treatment require surgery. Primary direct ligation of the bleeding vessel carries a risk of recurrence and prevents subsequent embolization. Under these conditions, when the surgeon prefers a conservative approach, preoperative embolization using permanent material can be performed as reported in our case study.

Accidents, Traffic↗
PubMed1993

Prognosis of rectal cancer in France.

We studied changes in the prognosis of cancer of the rectum (excluding the rectosigmoid junction) from 1978 to 1986 in the French department of Calvados on the basis of the 616 cases in the cancer registry. Taken as whole, survival has improved slightly with time (P < 0.01), but the improvement is only significant for men (P < 0.02), patients under 70 years (P < 0.01) and patients living in urban areas (P < 0.05). With regard to tumour characteristics, the improvement was significant only for patients with Dukes' stage C tumours at surgery (P < 0.02). To determine the reasons for the improvement in survival, the year of diagnosis and all other prognostic factors were studied in a multivariate model. Diagnostic conditions such as age and tumour stage did not vary from 1978 to 1986; in contrast, the rates of tumour resection and adjuvant radiation therapy increased, possibly explaining at least part of the improvement, particularly for patients with Dukes' stage C tumours.

Aged↗
PubMed1993

[Pseudotumoral hyperplasia of Brunner's glands].

Hyperplasia of Brünner's glands is a dysembryoplastic or hyperplasic lesion with an elective location of the proximal duodenum. Symptoms are often non-specific but severe manifestations can occur (haemorrhage, duodenal obstruction). Two cases of hyperplasia of Brünner's glands were reported due to their particularly large size and a misguiding clinical appearance. Difficulties in diagnosis due to this rare benign entity were discussed.

Adult↗
PubMed1993

[Surgical treatment of supralevator rectocele. Value of transanal excision with automatic stapler and linear suture clips].

A retrospective review of 20 rectoceles performed over a four year period (1988-1991) was carried out. The major indication for repair was constipation and outlet obstruction. All patients were objectively quantified by standardized defecography and functional investigations. All patients were repaired via a trans-anal approach using a linear stapler. Sixteen patients were improved with a mean follow-up of 21.8 months.

Adult↗
PubMed1992

[Ileovaginal fistula after ileo-anal anastomosis. Recovery by transposition of the gracilis muscle. Good anatomical and functional result].

One women developed a pouch-vaginal fistula after reconstructive proctocolectomy for ulcerative colitis. This study describes the risk factors which predispose to the development of this rare complication, as well as the various treatment options available. A diverting ileostomy was maintained and gracilis muscle interposition flap was used to treat the patient. An excellent result was achieved. This procedure can be useful in this rare but distressing complication.

Adult↗
PubMed1992

[Assessment of the practice of adjuvant radiotherapy in cancer of the rectum in the department of Calvados].

The effectiveness of adjuvant radiotherapy (ART) in the treatment of rectal cancer (RC) is established for the local control of the tumor, but doubt remains as concerns improvement in survival. The aim of this work was to assess the present techniques and trends of ART in a French department based on a population-based study. From 1978 to 1986, 616 cases of RC were diagnosed in the department of Calvados (France). Tumor was removed in 346 patients (56 percent). Of these 346 cases, 29 percent were irradiated, 3/4 postoperatively and one forth preoperatively. Besides sex and age, the type of surgery (anal sphincter saving or not) and Dukes' tumor stade had an influence on the performance of ART. Thirty-one percent Dukes B tumors and 42.1 percent of Dukes C tumors were irradiated. The practice of ART for these tumors increased significantly from 1978 (18.5 percent) to 1986 (60 percent) (P less than 10(-4)). However, the practice and the distribution of centers performing ART were heterogenous within the department of Calvados. This heterogeneity was neither due to the environment (urban/rural) of the patient nor to the distance between the place of residence and the radiation therapy center. Such an heterogeneity could be explained only by the lack of consensus concerning the practice of ART. Such a consensus could be found considering the results of the latest controlled clinical trials, but definitive conclusions are needed about the effectiveness of ART on the improvement of survival.

Adenocarcinoma↗
PubMed1992

[Adenocarcinoma on endobrachyesophagus. Results and prognostic factors apropos of 19 cases surgically-treated].

The authors report about a retrospective series of 19 operated patients with adenocarcinomas in a columnar lined esophagus. The resection rate was 95%, the postoperative mortality rate was 5.5%. The survival rate following curative exeresis (n = 14) was 32% (+/- 14) at 5 years. All patients with a stage III lesion died after 2 years, while 46% (+/- 19) of those with stage I or II tumors (p less than 0.001) survived at 5 years. In a multivariative analysis, the most important prognostic factor is the histological grade (p less than 0.01), then the extension to the lymph nodes (p less than 0.1). As the adenocarcinoma often reveals the columnar lined esophagus, the improvement of the prognosis certainly depends on the evaluation of the treatment, which combines pre- or postoperative radiation and chemotherapy, in multidepartmental prospective studies.

Adenocarcinoma↗
PubMed1992

[Ileo-vaginal fistula after ileoanal anastomosis. Recovery by transposition of the gracilis muscle. Satisfactory anatomical and functional result].

One woman developed a pouch-vaginal fistula after reconstructive proctocolectomy for ulcerative colitis. This study describes the risk factors which predispose to the development of this rare complication, as well as the various treatment options available. A diverting ileostomy was maintained and gracilis muscle interposition flap was used to treat the patient. An excellent result was achieved. This procedure can be useful in this rare but distressing complication.

Adult↗
PubMed1991

[Local surgical treatment of anal-perineal lesions in Crohn's disease. Retrospective study of 68 cases].

Sixty eight cases of ano-perineal lesions (APL) were studied. Lesions were classified into primary (19) and secondary (49) after Hughes. The course of primary APL was favourable (15 cases, 78 p. cent) when proximal CD was controlled, with 4 proctectomies being required when the latter was not the case. Suppurative secondary APL (48) were treated surgically either for an acute abscess (22) or for a chronic fistula (low: 14; high: 12). The treatment of fistulas involved: opening in 10 cases (4 recurrences, 5 failures) or slow fistulotomy with elastic in 17 cases (9 recurrences, 4 failures). Genital fistulas (9 cases) were studied separately: 3 recto-vaginal fistulas resulted in a permanent bypass and 6 ano-vulval fistulas healed or were tolerated. When proximal CD was controlled medically, proctological treatment alone resulted in the healing or quiescence of APL in 17/24 cases. In the group of patients undergoing intestinal resection with restoration of continuity, 10/25 recurred, with the appearance of worsening of an APL in 9 of them. Fifteen had no recurrence, with the appearance or worsening of an APL in 3 of them. In total, 13 patients (19 p. cent) underwent proctectomy, including 6 from the outset. Five had a stroma which was left open and 46 (72 p. cent) a functional anus. Local surgical treatment improved the comfort of patients without any increased risk regarding sphincter function, but the long term benefits of the active treatment of chronic fistulas remain to be proven.

Adolescent↗
PubMed1990

[New surgical procedure for the protection of the small intestine before postoperative pelvic irradiation].

A prosthesis was designed to protect the intestinal loop from external beam radiation therapy when post-operative radiation is indicated. It is a silicone inflatable balloon, which, when implanted displaces the intestinal loops out of the pelvic irradiation field. The prosthesis can be deflated between each course of irradiation, without surgery. The device has been used in 8 patients: 6 patients with recurrent pelvic tumor (2 rectal cancers, 1 anal cancer, 1 cancer of the endometrium, 1 cervical carcinoma, 1 ovarian carcinoma), 2 patients with primary tumor (1 malignant paraganglioma, 1 cervical carcinoma). Radiotherapy was administered by means of high power appliances. After radiotherapy, the prosthesis was deflated, then removed through a 3 cm incision under local or peridural anesthesia. The tolerance of the small intestine to the radiation therapy has been satisfactory in each case with no bowel injury due to radiation. Therefore, this simple device might be useful to prevent bowel injury during postoperative radiation in the treatment of abdominal and retroperitoneal tumor masses.

Combined Modality Therapy↗