PubMed Health⌕ Search

Biomedical subjects

J Testart

Publications and source records attributed to J Testart.

At least 37 records · Page 2Linked to original sources
PubMed1998

5-Fluorouracil and cisplatin as palliative treatment of advanced oesophageal squamous cell carcinoma. A multicentre randomised controlled trial. The French Associations for Surgical Research.

OBJECTIVE: To compare chemotherapy with no chemotherapy as palliative treatment for oesophageal squamous cell carcinoma. DESIGN: Randomised study. SETTING: Multicentre trial in France. SUBJECTS: Of 161 patients with histologically confirmed oesophageal squamous cell carcinoma located more than 5 cm from the mouth of the oesophagus, five were withdrawn because of protocol violation. The remaining 156 patients, 149 men and 7 women, mean (SD) age 58 (9) years range 36 to 77, were randomly allocated to either a control group without chemotherapy (n = 84) or a group treated by chemotherapy (n = 72). Patients were divided into four strata: I = complete resection of the tumour but with lymph node involvement (n = 62); II = incomplete resection of tumour leaving gross tumour behind (n = 58); III = no resection because of local or regional invasion (n = 22) ; and IV = no resection because of distant metastasis (n = 14). Exclusion criteria were histologically confirmed tracheobronchial involvement, oesophagotracheal fistula, Karnosky score < 50, cerebral metastases, or hepatic metastases occupying more than 30% of the liver, peritoneal carcinomatosis, associated or previously treated ear-nose-throat carcinoma, or complete resection of tumour without lymph node involvement. INTERVENTIONS: 5 fluorouracil (5FU) and cisplatin (CDDP) were given in 5-day courses, once every 28 days, for a maximum of eight cycles. 5 FU, 1 g/m2, was infused for 24 hours after a water overload, during five days. Cisplatin was given either in one dose of 100 mg/m2 at the beginning of the cycle or 20 mg/m2/day over three hours for five days. Duration of treatment ranged from 6-8 months. OUTCOME MEASURES: Median and actuarial survival. The subsidiary endpoint was quality of survival judged by complications of treatment, swallowing disorders, and the duration of ability to feed normally. RESULTS: There was no difference in survival, either overall (median = 12 months) or in any of the strata. There were however significantly more patients with neurological (p < 0.003), haematological (p < 0.0001), and renal (p < 0.0002) complications in the treated group compared with the control group. Four patients (6%) died of complications of chemotherapy. The course of swallowing disorders did not differ between the two groups. The duration of autonomous oral feeding was exactly the same in both groups (median = 10.5 months). CONCLUSION: The results suggest that 5FU and CDDP do not help in patients with squamous cell carcinoma of the oesophagus whether or not the tumour has been resected.

Adult↗
PubMed1997

Acquisition of meiotic competence is related to the functionality of the phosphoinositide/calcium signaling pathway in the mouse oocyte.

The meiosis resumption process has been related to spontaneous cytoplasmic InsP3-dependent calcium oscillations in fully grown mouse oocytes. Our purpose was to determine whether the acquisition of meiotic competence during the growth phase of oogenesis was associated with that of Ca2+ oscillations and whether these oscillations were dependent on the phosphoinositide cycle. We used confocal laser scanning microscopy to image free calcium ions in fluo-3/AM-loaded oocytes recovered from 12- to 26-day-old mice for 15 min following follicular release. As expected, oocytes isolated from 12-day-old mice were totally incompetent to undergo GVB in vitro, whereas the GVB rate increased progressively with mouse age and oocyte diameter. The percentage of oocytes exhibiting spontaneous calcium oscillations and that of oocytes resuming meiosis were similarly correlated with the female age, with incompetent oocytes failing to exhibit spontaneous Ca2+ oscillations. It is noteworthy that regardless of the stage of growth, thapsigargin induced an ooplasmic calcium release from the InsP3-sensitive stores when it was added to the culture medium. However, intracytoplasmic microinjection of InsP3 induced a shorter sequence of Ca2+ oscillations in 12-day-old mouse oocytes than in 15-day-old mouse oocytes and, whereas InsP3 increased the GVB rate at 15 days, it was unable to induce GVB at 12 days. These data lead us to conclude that the acquisition of meiotic competence is related to the functionality of the InsP3 pathway and, correspondingly, to the oocyte's ability to generate spontaneous cytoplasmic InsP3-dependent calcium oscillations.

Age Factors↗
PubMed1997

Femoropopliteal bypass: in situ or reversed vein grafts? Ten-year results of a randomized prospective study.

One hundred femoropopliteal bypass procedures performed in 91 patients between October 1980 and January 1985 were randomly divided into two statistically comparable groups including 50 in situ vein grafts and 50 reversed vein grafts. The indication for bypass was chronic critical ischemia in 97% of cases. The lower anastomosis was made on the distal popliteal artery in 75% of cases. Follow-up ranged from 10 years (for the last patient included) to 14 years. Three patients have been lost to follow-up. Median survival was 54 months in the in situ graft group and 76.5 months in the reversed graft group. Actuarial survival at 10 years was 30.8% in the in situ graft group and 29.5% in the reversed graft group. Actuarial limb salvage at 10 years was 73.5% in the in situ graft group and 74.4% in the reversed graft group. Graft occlusion was observed in 10 cases during the perioperative period (six in the in situ graft group and four in the reversed graft group) and in 19 cases during the late postoperative period (12 in the in situ graft group and seven in the reversed graft group). Reoperation during follow-up was required in 13 cases in the in situ graft group (11 patients) and in nine cases in the reversed graft group (five patients). Discounting residual arteriovenous fistulas (FAV) (five ligations in four patients), the incidence of lesions involving the bypass and anastomoses threatening graft patency was 6% in the in situ graft group and 8% in the reversed graft group. Actuarial primary patency at 10 years was 41.7% in the in situ graft group and 64.5% in the reversed graft group (p < 0.05). Actuarial secondary patency at 10 years was 64.8% in the in situ graft group and 70.2% in the reversed graft group (NS). As a function of vein diameter, actuarial secondary patency at 10 years in the in situ graft group was 37.5% for bypasses using veins with a diameter of 4 mm or less and 80.6% for bypasses using veins larger than 4 mm (p < 0.05). In the reversed graft group the patency rate was 71.2% for bypasses using veins with a diameter of 4 mm or less and 65.5% for bypasses using veins larger than 4 mm. In addition to requiring a training period the in situ technique raises the problem of valve removal especially for small diameter veins. The absence of these disadvantages makes the reversed technique the procedure of choice for femoropopliteal bypass.

Aged↗
PubMed1997

[Surgery of carotid lesions after irradiation. Apropos of 15 cases].

Out of 15 patients operated on for a carotid stenosis 3 to 19 years after a cervical irradiation, 2 were treated by a subclavian-carotid by-pass, 3 by a common carotid-internal carotid by-pass, 10 by an endarterectomy (6 closed with a patch), 3 of these endarterectomy extended largely down on the common carotid. Although the surgical approach was often difficult through the sclerotic tissues and 8 times the scar of a lymphadenectomy, the removal of the atherosclerotic core was as easy as usual. We observed neither mishap in arterial and cutaneous healings nor post operative stenotic myointimal hyperplasia.

Adult↗
PubMed1997

[Lumbar sympathectomy by retroperitoneal endoscopy: feasibility study].

Endoscopic surgery has been used as a new procedure to simplify different surgical processes. The goal of this study was to evaluate the benefits of endoscopic retroperitoneal surgery for lumbar sympathectomies. Between February 93 and November 95 we performed 35 lumbar sympathectomies using this technique. All patients were arteritic. The results were as follows: for 25% of the patients, conversion classical open technique was required; 6% complications (septic); 3% of the patients died. In comparing the various techniques of sympathectomy and sympatholysis, it would appear that the endoscopic technique produces fewer complications. However we believe that a learning period is necessary before this technique can be fully mastered.

Adult↗
PubMed1996

Lectins binding on human sperm surface increase membrane permeability and stimulate acrosomal exocytosis.

Cross-linked complexes formed between certain lectins and their specific multivalent carbohydrates and glycoconjugates on the sperm surface were studied for their ability to modify sperm membrane permeability and to induce the acrosome reaction. Wheat germ agglutinin (WGA), concanavalin A (Con A) and peanut agglutinin (PNA) increased the proportions of human spermatozoa permeable to the impermeable propidium iodide (31.9 compared with 13.8%, 38.4 compared with 18.4% and 72.7 compared with 18.9% respectively). Removal of sperm surface sialic acid by neuraminidase treatment was a prerequisite for Con A and PNA binding to the sperm surface. The percentage of permeable and acrosome-reacted spermatozoa was not affected by sperm treatment with 500 mIU/ml Arthrobacter ureafaciens neuraminidase. WGA did not induce the acrosome reaction, whereas PNA induced the acrosome reaction regardless of the sperm capacitation status, allowing the proportion of acrosome-reacted spermatozoa to reach 27.7% of capacitated spermatozoa. However, the ability of Con A to induce the acrosome reaction was limited to uncapacitated spermatozoa. To test the physiological relevance of this study, uncapacitated human spermatozoa were incubated with human zonae pellucidae and the permeability of spermatozoa bound to the zona surface was analysed according to the time post-insemination. Two-thirds of spermatozoa bound to zona pellucida became permeable to propidium iodide in the first 30 min post-insemination and almost all bound spermatozoa became permeable to the impermeable dye after 60 min. Our results show that molecular interactions between human zona pellucida and sperm surface increase the permeability of sperm membranes; the cross-linked complexes formed by PNA lectin and its specific multivalent carbohydrates and glycoconjugates on the sperm surface were also able to increase sperm membrane permeability and to induce the acrosome reaction. These results suggest a role for the saccharide moieties of sperm surface glycoconjugates in the induction of the acrosome reaction.

Acrosome↗
PubMed1996

Intracytoplasmic sperm injection in infertile patients with structural chromosome abnormalities.

In the present study we investigated the results of cytogenetic analysis in male and female patients included in an intracytoplasmic sperm injection (ICSI) programme for severe male infertility as well as in conceptuses resulting from these ICSI treatments. In the 261 couples treated, 11 male (4.2%) and three female (1.2%) abnormal karyotypes were found, all consisting of structural chromosome anomalies. Chromosomal translocation exhibited the highest frequency (eight males and two females), and there were also three cases of chromosomal inversion (two males and one female) and one male with one additional marker chromosome. There was no difference in fertilization rates among couples with abnormal (n = 14) and normal (n = 147) cytogenetic results, and the rates of clinical pregnancy per ICSI attempt were 25.0% (5/20) and 20.6% (78/ 378) respectively. In pregnancies obtained in couples with normal karyotypes, all of the 108 fetuses were free of chromosomal abnormalities. Among the eight fetuses from couples with chromosome structural anomalies, three out of five and two out of three inherited from the cytogenetic defects found in their father or mother respectively. In this series of 83ICSI pregnancies there were no chromosomal abnormalities other than those inherited from the parents. These findings suggest that normal pregnancy rates can be obtained by ICSI in cases of chromosomal translocation in couples with severe male infertility. However, until further evaluations of available data can be performed, cytogenetic analysis must be conducted prior to ICSI in men with low sperm counts, and genetic counselling must include prenatal diagnosis for all growing conceptuses.

Chromosome Aberrations↗
PubMed1996

[Coronary assessment and surgery for aortic aneurysm: a pragmatic attitude].

High prevalence of coronary artery disease in patients with AAA leads to a high rate of peri-operative cardiac complications. Coronary insufficiency is thus the cause of 40 to 60% of post-operative deaths after aortic surgery. Demonstration of coronary insufficiency depends on the clinical history, electrocardiographic evidence, non-invasive examinations and coronarography. Diagnosis is based on non-invasive tests, and of primary importance exercise tests, which have a high sensitivity. Specificity for predicting post-operative cardiac complications remains low but can be improved by combining with other tests (for example exercise test and Holter recording) or with other clinical parameters. Coronarography provides a precise map of the coronary status but gives little information on functional impairment of encountered lesions. Finally, besides the cost and a certain degree of morbidity, coronarography increases the number of indications for revascularizations with the inconvenience of its intrinsic mortality and also retards the operation increasing the risk of rupture. The evaluation of cardiac risk before surgery must be based on correct use of non-invasive tests, limiting coronarography to cases with frankly positive tests.

Aged↗
PubMed1996

[Dissecting aneurysm of the external iliac artery. An unusual course of endofibrosis in an athlete].

A 42-year-old man was consulted because of a pain in his left leg. He was a highly trained biker since 20 years. The echo-Doppler and arteriography evidenced a stenosis, probably due to endofibrosis of the external iliac artery. In addition, it showed an aneurysm and an intimal dissection of this artery. The arteriography confirmed this diagnosis, and normal aspect of the other arteries. Neither conservative nor endovascular treatments were possible because of the anatomic lesions. We resected the external iliac artery and performed a by-pass with the great saphenous. The result at the 5th month was clinically good. The echo-Doppler control did not show any abnormality. The natural course of the endofibrosis of athletes is unknown, although stenosis, revealed by intermittent claudication is usually observed. Only a few cases of dissection and no aneurysmal degeneration have been described before.

Adult↗
PubMed1996

[Thrombo-aspiration in the surgical treatment of acute ischemia of the legs. Preliminary experience].

Eleven thrombo aspirations were performed in ten patients with lower limb acute ischemia. Three were performed under local and 8 under general anesthesia. They were associated with 4 thrombectomies, 6 transluminal angioplasty procedures, 1 limb infusion, 1 treatment of a false aneurysm, 1 aponeurotomy, 1 angioscopy. Clinical and radiological success was achieved in 9 patients whereas there was one immediate failure requiring a popliteal distal bypass. Late partial rethrombosis requiring medical treatment occurred in one patient. Thrombo aspiration is a safe effective technique which can be combined with other endoluminal procedures in patients with acute lower limb ischemia.

Acute Disease↗
PubMed1995

Cytoplasmic and nucleic calcium oscillations in immature mouse oocytes: evidence of wave polarization by confocal imaging.

Using confocal laser scanning microscopy and time-lapse reconstruction, we monitored [Ca2+]i in living mouse oocytes loaded with the calcium-sensitive fluorescent dyes fluo-3/AM or NuCa Green (specific for nuclear calcium) at the time of meiosis reinitiation. Our data confirm that spontaneous Ca2+ oscillations occurred in most of the immature fully grown mouse oocytes at least during the first half hour after release of the follicle and these oscillating oocytes underwent GVB in a large proportion after 1 h of culture. These spontaneous oscillations were disrupted when GVB was inhibited by dbcAMP and suppressed in the absence of external calcium. They were dependent on intracellular InsP3-sensitive Ca2+ stores since they were inhibited by heparin, an InsP3-receptor antagonist, or thapsigargin, which depletes InsP3-sensitive Ca2+ stores. A relation appeared between the germinal vesicle chromatin appearance and the oocyte's ability to exhibit calcium oscillations. NuCa Green-loaded oocytes exhibited clear fluorescence oscillations in the nuclear region which lead us to discuss the implication of the nuclear calcium in the meiotic process. Moreover, the observation of a clear polarization of the Ca2+ waves in 30% of the oocytes permits us to hypothesize the existence of a predetermined localization for the initial point of the calcium wave.

Aniline Compounds↗