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Biomedical subjects

J P Sales

Publications and source records attributed to J P Sales.

At least 19 recordsLinked to original sources
PubMed2001

[Role of ambulatory surgery in France. International comparisons].

Ambulatory surgery in France was under constraining rules since 1992. In 1998, there were 7,600 ambulatory stations which allowed 2,700,000 ambulatory procedures in a year. French Association for Ambulatory Surgery and International Association for Ambulatory Surgery adopted a limited list of 18 reference procedures to launch a survey on the prevalence of ambulatory surgery. The prevalence rate of ambulatory procedures among this list raised from 35.2% in 1997 to 39.3% in 1999. This rate was the same in public and private health institutions. Ambulatory practice was increasing more than the inpatient procedures. Inter-country comparisons pointed out France as the tenth country for ambulatory prevalence among 13 members of Organization for Economic Cooperation and Development. This underlined the fact that there was probably a growth potential for ambulatory surgery in France.

Ambulatory Surgical Procedures↗
PubMed2001

Carcinoembryonic gene member 2 mRNA expression as a marker to detect circulating enterocytes in the blood of colorectal cancer patients.

BACKGROUND: The aim of this study was to report our experience with a new molecular tool to detect circulating enterocytes in the blood of patients with colorectal cancer. METHODS: The study included 193 individuals: 78 patients with colorectal cancer and 115 controls composed of patients with benign colorectal diseases (n = 16), patients with noncolorectal cancer (n = 31), healthy individuals (n = 62), and healthy bone marrow transplantation donors (n = 6). A nested reverse transcriptase-polymerase chain reaction with specific primers for the carcinoembryonic gene member 2 (CGM2) was used to detect circulating enterocytes in the peripheral blood of 78 patients with colorectal cancer. The blood (n = 109) or the bone marrow (n = 6) of the 115 controls was studied to test the absence of CGM2 illegitimate transcription in nucleated blood cells and nucleated blood cell progenitors. The assay sensitivity was effective in detecting 1 CGM2-positive cell per 10(6) nucleated blood cells. RESULTS: Fifty-nine percent (46/78) of patients with colorectal cancer were found positive whereas all negative controls remained negative. Positivity rates were 38% (3/8) in Dukes' A classification, 43% (9/21) in Dukes' B, 77% (23/30) in Dukes' C, and 58% (11/19) in Dukes' D. CONCLUSIONS: The clinical significance of enterocyte detection in the blood of colorectal cancer patients by means of this CGM2 messenger RNA assay needs further evaluation.

Adult↗
PubMed2001

[Role of ambulatory surgery in France -- international comparisons].

Ambulatory surgery in France was under constraining rules since 1992. In 1998, there were 7,600 ambulatory stations which allowed 2,700,000 ambulatory procedures in a year. French Association for Ambulatory Surgery and International Association for Ambulatory Surgery adopted a limited list of 18 reference procedures to launch a survey on the prevalence of ambulatory surgery. The prevalence rate of ambulatory procedures among this list raised from 35.2% to 39.3% in 1999. This rate was the same in public and private health institutions. Ambulatory practice was increasing more than the inpatient procedures. Intercountry comparisons pointed out France as the tenth country for ambulatory prevalence among 13 members of Organization for Economic Cooperation and Development. This underlined the fact that there was probably a growth potential for ambulatory surgery in France.

Ambulatory Surgical Procedures↗
PubMed2001

[Gastric epithelioid angiosarcoma, a biopsy diagnostic pitfall].

We report the case of a 70-year-old man who presented a bulky gastric mass. The diagnosis of poorly differenciated adenocarcinoma was made on the biopsy. On surgical specimen, the final diagnosis of gastric angiosarcoma with secondary intestinal involvement was established. The patient did not respond to chemotherapy and died 8 months later. The diagnosis was difficult because of epithelioid areas which expressed both cytokeratin and vascular antigens. Human herpesvirus 8 previously detected in some soft tissue angiosarcoma was not found by polymerase chain reaction.

Aged↗
PubMed2000

[Role of somatostatins in the preventin of pancreatic fistulae and the treatment of digestive fistulae].

Somatostatin and analogues exert an extraordinary range of inhibitory effects which eventually may have a variety of therapeutic applications. Treatment of intestinal and pancreatic fistula are the main targets in general and digestive surgery. The perioperative and prophylactic application of somatostatin or octreotide in patients who undergo major pancreatic surgery reduces the postoperative complication rate. This prevention seems indicated following Whipple procedure in patients with soft pancreatic tissue. The efficacy of somatostatin or analogues in the treatment of intestinal or pancreatic fistulae is still in debate. Fistula output frequently decreases but closure rate, healing time and complications rate are not reduced. The treatment and care of patients with high output fistulae may be simplified by somatostatin or analogues if a positive effect on output is obvious in the first days of treatment.

Hormones↗
PubMed2000

[Contribution of ambulatory digestive surgery].

In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept.

Adolescent↗
PubMed1999

[Results of laparoscopic treatment of perforated ulcers].

STUDY AIM: The aim of this retrospective survey was to evaluate the results of laparoscopic treatment in perforated peptic ulcer. PATIENTS AND METHODS: From 1989 to 1998, 84 patients were operated on for perforated ulcer. Sixty nine patients, operated on with videolaparoscopy, were included in this study: 53 men and 12 women with a mean age of 45 +/- 16 years (19-85). Nine had a history of peptic ulcer disease and 12 received anti-inflammatory drugs. Perforation occurred in the duodenum (60 patients) and in the stomach (five patients). Laparoscopic treatment included peritoneal lavage and either a simple duodenal closure (51 patients), a closure with a highly selective vagotomy (one patient), an epiplooplasty (eight patients), or an excision-closure for the gastric ulcers (five patients). Drainage was associated in 38 patients (58%). RESULTS: A conversion into laparotomy was necessary in six patients. Among the 59 patients treated with laparoscopy, 56 were only managed laparoscopically, three had exploration and peritoneal lavage through laparoscopy, and underwent suture of the perforation through minilaparotomy. Mean operative time was 105 +/- 40 minutes (30-240). Mean postoperative hospital stay was 8.2 +/- 4 days. Reoperation was performed in three patients for leakage (n = 2) and gall bladder perforation (n = 1). Complications were medically treated in three patients. There was no in-hospital mortality. CONCLUSION: Laparoscopic management in perforated peptic ulcer is successful in 90% of the patients. Results are good. There was no postoperative death in this series.

Adult↗
PubMed1999

Biochemical characterization of a Ca2+/NAD(P)H-dependent H2O2 generator in human thyroid tissue.

An NAD(P)H-dependent H2O2 forming activity has been evidenced in thyroid tissue from patients with Grave's disease. Its biochemical properties were compared to those of the NADPH oxidase previously described in pig thyroid gland. Both were Ca2+-dependent and activated by inorganic phosphate anions in the same range of concentrations. Both are flavoproteins using FAD as cofactor, but the human enzyme was also able to utilize FMN. The apparent Km for NADPH of the human enzyme (100 microM) was 5-10 times higher than that of porcine enzyme. Vm was 3 to 10 times higher in pig (150 nmol x h(-1) x mg(-1)) than in man (14 to 45). Total content in human tissue was 7 to 9% of that in porcine tissue. An unidentified inhibitor has been detected in the 3000 g particulate fraction from most patients, which could account for this apparently low enzyme content. An NADH-dependent H2O2 production has also been observed in porcine and human thyroid tissues. This activity was only partly Ca2+-dependent (man, 50-70%; pig, 80-90%) and presented similar apparent Km values for NADH (man, 100 microM; pig, 200 microM). In pig thyrocytes, the expression of the Ca2+-dependent part of the NADH-oxidase activity was induced by TSH and down-regulated by TGFbeta, as was the NADPH oxidase activity. Furthermore, NADPH and NADH-dependent activities were not additive. We conclude that a single, inducible, NAD(P)H-oxidase can use NADPH or NADH as substrate to catalyse H2O2 formation, and that human and porcine NAD(P)H-oxidases are highly similar. Differences observed could be attributed to minor differences in enzyme structure and/or in membrane microenvironment. The NADH-dependent Ca2+-independent activity observed in human and porcine thyroid fractions could be attributed to a distinct and constitutive enzyme.

Animals↗
PubMed1998

Anatomy of spontaneous splenorenal and gastrorenal venous anastomoses. Review of the literature.

Portal hypertension is characterised by the development of a collateral portocaval circulation. Among these venous reroutings, some are situated posteriorly in the left subphrenic compartment. These are the spontaneous splenorenal and gastrorenal anastomoses. Their incidence is estimated at around 16%. On the one hand, there are the direct shunts, which anastomose the spelling v. to the left renal v., of an anecdotal nature, and on the other the spontaneous indirect splenorenal shunts, characterised by the presence of a complete neurovascular pedicle traversing the gastrophrenic ligament. This relates to the gastric collateral v., which is connected to the left renal v. via the inferior v. of the left crus of the diaphragm and the middle capsular v., hence the name "gastro-phreno-capsulo-renal shunt". At an advanced stage of portal hypertension these splenorenal shunts may acquire a major caliber and behave like actual surgical shunts.

Collateral Circulation↗
PubMed1998

[Evaluation and interest in new molecular markers in colon cancer].

The presence of colonic tumor cells in the circulation may predict colorectal carcinoma recurrence and metastases. We have developed a highly sensitive nested RT-PCR assay, with primers derived from the cytokeratin 20 (CK20) and the carcinoembryonic gene CGM2, to detect occult microdisseminated enterocytes in blood of colorectal cancer patients. Among 82 healthy controls analyzed, 40.2% (33/82) have a positive expression of CK20 mRNA which is not statistically different from the 45.5% (15/33) of positive results found in colon cancer patients. This sensitive method may detect non-tissue specific constitutive low level (illegitimate) expression of CK20 mRNA in peripheral nucleated blood cells (PNBC) of a significant number of healthy control as well as in a number of normal bone marrow. The low specificity of this assay therefore hampers its value to detect blood colon cancer dissemination. In 47 patients with colorectal carcinoma, CGM2 primers detected circulating enterocytes in 25 of them (53%). In disseminated Dukes' stage C disease patients, 17 out of 29 (59%) were found positive whereas in localized adenocarcinoma (Dukes's stage A and B), CGM2 primers detected enterocytes in 44% suggesting that an hematogenous spillage of colonic cells may be a relatively early event in colon cancer. None of the patients suffering from benign colonic pathologies or from diverticulitis were found positive for this assay. The analysis of 56 healthy individuals without known colorectal cancer, of 20 non-colorectal cancer patients and of 6 normal bone marrows provide evidence that this assay is highly specific and may predict an hematogenous spread of colonic cells in patients with organ-confined disease. Nevertheless, the clinical significance of enterocyte detection and the potential applications of this molecular tool merit longer term follow-up.

Biomarkers↗
PubMed1995

Intraperitoneal fluid collection after laparoscopic appendectomy. Sonographic analysis in asymptomatic patients.

The aim of this prospective study was to evaluate the frequency of postoperative fluid collection after laparoscopic appendectomy in patients with normal postoperative development. Twenty-eight patients were included. The surgical technique, histological data, and postoperative development during the first postoperative month were recorded. A sonographic analysis was performed on the 5th postoperative day by a radiologist who was not aware of the histological and surgical data. Ten cases of fluid collection were found (37%). The frequency was higher in cases of suppurated appendicitis and significantly higher with associated periappendicitis. Peritoneal irrigation or retrocecal dissection did not influence the occurrence of fluid collection. Postoperative serous fluid collection occurs with a high frequency after laparoscopic appendectomies, and one must be careful in interpreting sonographic analyses in looking for deep abscesses in patients with difficult postoperative development.

Adolescent↗
PubMed1994

[Did the stage of diagnosis and the surgical management of colonic cancers change over the last ten years? Apropos of 303 patients].

The major prognostic factors in colonic cancer are parietal invasion, lymph node spread and distant metastasis, as summarized in the Dukes classification. The aims of this study were to find any variation of these parameters between patients operated in 1981 and those operated in 1991 and whether the mortality and morbidity rate were modified. One hundred and twenty seven patients in 1981 and 176 in 1991 were considered. Age, sex, clinical features, tumor staging and histologic data were reviewed. Mortality and morbidity rates were established. Mean age was 67 (+/- 14) in 1981 and 69 (+/- 15) in 1991. Obstructing carcinomas were present in 8 cases (7%) in 1981 and 20 (13%) in 1991. At laparotomy, metastases were found in 16 cases (13%) in 1981 and 25 (14%) in 1991. Tumors were resectable in 22 patients (17%) in 1981 and in 23 (14%) in 1991. Tumor staging showed in 105 specimens in 1981: 24 Dukes' A (23%), 39 Dukes' B (37%), 26 Dukes' C (25%) and 16 Dukes' D (15%). In 1991, the study of 153 specimens found 23 Dukes' A (15%), 52 Dukes' B (35%), 54 Dukes' C (36%) and 24 Dukes' D (16%). None of the differences were statistically significant. Overall mortality rate in 1981 was 4.3% (5 patients including two anastomotic leaks) and 6 (5.2%) patients were operated for surgical complications including 5 anastomotic leaks. In 1991, 3 patients (1.7%) were operated and only one for an anastomotic leak. There were no deaths. Mortality and morbidity rates were significantly different (p < 0.05) between 1981 and 1991. As far as Dukes classification is concerned, the prognostic variables of colonic cancers have not changed over this ten-year period. On the other hand, the progress in surgical management allows curative resection without mortality.

Adenocarcinoma↗
PubMed1994

[Entero-enteral fistulas in Crohn disease: radical or conservative surgical treatment of the "victim" segment?].

OBJECTIVES AND METHODS: Entero-enteral fistulas join a segment affected by Crohn's disease to another which becomes a drainage route and a "victim" of the process. Surgical treatment can be radical (extensive resection of both segments) or conservative (resection of involved bowel and conservation of the "victim"). Fifty-nine patients operated on for Crohn's disease and having 80 entero-enteral fistulas were retrospectively studied. RESULTS: Main surgical indications were symptomatic intestinal stenosis (56%) or abdominal mass (20%) unresponsive to medical treatment. Fistula was discovered during operation in 33 patients (56%). Conservative treatment was performed in 39 fistulas (49%). In 41 fistulas (51%), proximity of fistulous ends, or Crohn's disease's extension, led to radical treatment. In 66 fistulas (82.5%), histologic examination revealed that Crohn's disease affected only one bowel segment, the other demonstrating only non specific features; in the 14 remaining fistulas (17.5%), Crohn's disease affected both segments. CONCLUSIONS: The clinical presentation of entero-enteral fistulas (non-specific symptoms, frequent peroperative diagnosis), their pathological features (victim segment often free of Crohn's disease) plead for a conservative surgical approach, i.e. adapted to real bowel involvement by Crohn's disease.

Adolescent↗